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Diagnostic Coding for Gastroparesis: A Chronic Syndrome of Gastrointestinal Tract

Coding


Diagnostic Coding for Gastroparesis: A Chronic Syndrome of Gastrointestinal Tract

Date Posted: Tuesday, August 31, 2021

 

Gastroparesis is a clinical disorder that influences the normal peristalsis movement of the muscles in your stomach. Typically, a proper muscle contraction and relaxation propel the meal in your gastrointestinal tract. 

Stomach muscles, which are controlled by the vagus nerve, move the food via the GI tract. It can disrupt the normal functioning of the stomach muscles if any specific damage to the vagus nerve occurs.

If you have gastroparesis, it will prevent your stomach from emptying properly, and your stomach motility doesn't work or may slow down. In this way, it becomes difficult to propel the pulverized food into the small intestine where further absorption and digestion of nutrients occurs.

Sign and Symptoms
This disorder can be life-threatening and extremely debilitating. However, its symptoms or signs vary in frequency and intensity. In some scenarios, its symptoms aggravate and occur after or during the meal (typically containing foods with a lot of fiber, fatty foods, rich foods, and carbonated beverages). Weight loss may also occur. Additionally, a feeling of fullness after starting a meal is very common. 

Complications 
Patients often have both gastroparesis and diabetes, in which the food leaves the stomach to travel to the intestine and the blood glucose level rises quickly, leading to other problems, as well, including malnutrition (poor nutrition) and dehydration (extreme thirst).
 
Causes 
Diabetes is often regarded as the most common cause of gastroparesis. Some medications, such as antidepressants, narcotics, allergy medicines, opioid pain relievers, and high blood pressure medications, can cause acid reflux, stomach pain, abdominal bloating, and delay stomach emptying. Other causes involve viral and bacterial infections. 

Apart from uncontrolled diabetes, medications, and surgeries, other potential causes of gastroparesis include:

  • Hypothyroidism
  • Nervous system complications (for instance, multiple sclerosis or Parkinson's disease)
  • Connective tissue disorders (such as muscular dystrophy or multiple sclerosis)

Test and Diagnosis 
Initial diagnosis starts with the doctor inquiring about the past health condition and current symptoms. This is the right time to disclose the medications you are already taking. The doctor will perform the physical examination once he/she suspects gastroparesis by performing the following diagnostic tests:

  • An upper endoscopy 
  • A blood test
  • An MRI scan
  • A gastric manometry
  • An upper gastrointestinal series (UGI)
  • An ultrasound (which creates images using sound waves to look for diseases in the gallbladder or pancreas that show symptoms)

At this point, awareness about the symptoms, causes, and risk factors is critical for making early diagnosis and treatment easier. Therefore, developing strategies to improve treatment, diagnosis, and prevention of this disease is the need of the hour. 

It's time to educate the general public about the prominent symptoms of this condition. That's why monthly campaigns play a crucial role for awareness purposes. 

August is considered as the 'Gastroparesis Awareness Month'; throughout the whole month, IFFGD (International Foundation for Functional Gastrointestinal Disorders) raises awareness about the quality of life and challenges for people living with these complications. 

Treatment 
There is no specific cure for this disorder. Following medications, along with an appropriate balanced diet, can help you control the symptoms in the long run. However, treatment for gastroparesis is directly dependent on the severity and underlying causes of the symptoms. 

Patients having diabetes are especially advised to reduce the problems of gastroparesis by managing their blood glucose levels. Treatment procedures involve an amalgam of modalities, such as lifestyle and dietary measures, medications, and surgical methods. 

Surgical methods involve Parenteral nutrition, Gastric electrical stimulation (Enterra), Enteral nutrition, and other procedures.

Medications
Medications are prescribed by physicians to stimulate the stomach muscles, including erythromycin and metoclopramide (Reglan), ondansetron (Zofran), prochlorperazine (Compro), and diphenhydramine (Unisom, Benadryl). 

Significance of Proper Documentation
Medical practitioners treating such types of conditions must accurately document the claims. Gastroenterology medical coding/billing is quite challenging in the healthcare landscape. 

You are required to enter the exact symptoms, causes, screening tests, diagnosis, or conducted treatment methods and apply the accurate medical codes when documenting gastroparesis. 

A reputable gastroenterology medical billing company provides medical coding outsourcing services to help healthcare providers use the precise codes for their billing/coding procedures. 

To report gastroparesis in ICD-10, use diagnosis code K31.84.

LCDs for Gastrointestinal Services 
For demonstrating the medical necessity for successful billing and correct coding, proper documentation is essential. If you fail to display medical necessity, it will lead to denials and authorization rejections for diagnostic studies, medications, lab tests, etc.  

Commercial payers and Medicare usually have (local coverage determinations) LCDs for testing and various procedures, accompanying officially accepted diagnosis codes along with restrictions and indications. 

Some examples of Medicare's LCDs for gastrointestinal and gastroesophageal procedures or services are the following:

  • CPT code 0355T - Colon Capsule Endoscopy (CCE)
  • CPT codes 91110 and 91111 - Wireless Capsule Endoscopy
  • CPT code 43284 - for the treatment of GERD (Gastroesophageal Reflux Disease) LINX® Reflux Management System
  • CPT code 43257- for the treatment of GERD (Gastroesophageal Reflux Disease) Endoscopic Procedures

Ileus and Bezoars
The ileus can cause intestinal obstruction and result in a blockage or build-up of food material, resulting in a lack of movement in the intestine. 

While bezoars accumulate in the digestive tract, it is a solid mass of indigestible food material that can cause nausea and vomiting. 

ICD-10-CM Codes for Ileus and Bezoars
In addition to this, the medical coder needs to code gastroparesis, as well as diabetes by type if the healthcare providers have recorded diabetes as the main underlying cause for that condition. Distinctive two conditions like ileus and bezoars should also be composed as a part of coding. 

For ileus and bezoars, ICD-10-CM codes are the following:

  • K56.7 - Ileus, unspecified
  • T18.2 - Foreign body in the stomach
  • K91.89 - Disorders of the digestive system and other post-procedural complications
  • T18.9 - Part unspecified foreign body in the alimentary tract
  • T18.3 - Foreign body in the small intestine

Coders are recommended to use one code if the postprocedural ileus induces an obstruction when the gastroenterologist documents it as a complication: K91.3 – Postprocedural intestinal obstruction.

However, above K31.84, the following codes contain annotation back-references which may apply to K31.84:

  • K31 - Other diseases of stomach and duodenum
  • K20-K31 - Diseases of duodenum, esophagus, and stomach
  • K00-K95 - Diseases of the digestive system

Summing Up
Gastroenterology practices often get benefits from billing professionals due to regular billing and coding changes or challenges associated with stomach disorders. Outsourcing your gastroenterology billing and coding to an experienced medical billing company will enable you to access qualified billers and coders. Trained billing specialists can help you reduce claim denials, eradicate mistakes, ensure clean claim submission, and maximize revenue.  


Sarah Khan, a content writer by profession, has extensive industry experience of more than 12 years. She's an award-winning creative entrepreneur. She is an accomplished academic writer and has been working as a co-author for many research projects. 

Her ability to craft a well-turned metaphor also distinguishes her among the top writers. She has been serving the healthcare industry for over a decade now, as she always comes with insightful articles regarding healthcare financial management, e.g., medical billing and coding, etc.  Contact Sarah at ikhan@medcaremso.com

Medcare MSO works with all practice management software as it specializes in GI billing and coding. You can witness improved revenue cycle management with complete accuracy while delivering quality healthcare services. We have been providing outsourced services like authorizations/insurance verifications and gastroenterology medical billing to many practices throughout the United States for more than 12 years. 

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