Beginning with this post, I shall commence a series called “APDC”, short for “Anatomy and Physiology Disease Coding”.

Posts will feature anatomy vectors incorporating display of diseases and conditions terms from the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).

My aim of these posts is to share ICD-10 coding experiences on common diseases and conditions with readers  who have just embarked on a new career in Health Information Management (HIM) / Medical Records (MR) management and as a refresher for ICD-10-experienced readers.

By common, I am only highlighting the diseases and conditions that I have frequently encountered  principal diagnoses found in medical records here in Malaysia, and perhaps in your region too.

Today let us look at diseases and conditions common to the duodenum, gall bladder, liver, and pancreas. The image below shows some of the common diseases and conditions found in medical records for the duodenum, gall bladder, liver, and pancreas (click on the image to view a larger image in a new tab of your current browser window).

ICD-10 Chapter XI is the chapter that contains the ICD-10 codes for diseases of the digestive system, including those affecting the duodenum, gall bladder, liver, and pancreas.

Alcoholic liver disease usually occurs after years of drinking too much. The longer the alcohol use has occurred, and the more alcohol that was consumed, the greater the likelihood of developing liver disease, causing swelling and inflammation (hepatitis) in the liver. Over time, this can lead to scarring and then cirrhosis of the liver. Cirrhosis is the final phase of alcoholic liver disease. Code K70.3 for alcoholic liver disease is advised..

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain. In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Other causes include severe illness and (rarely) tumors of the gallbladder. If it is recorded as acute cholecystitis, then use the ICD-10 code, K81.0, but many times it is just recorded as cholecystitis, thus just use K81.

The cystic duct is the short duct that joins the gallbladder to the common bile duct. Gallstones can enter and obstruct the cystic duct, preventing the flow of bile. Have you encountered jaudice sometimes recorded in the medical record? The occurrence of jaundice due to inflammation of the gallbladder neck and adjacent hepatoduodenal ligament resulting from a stone lodged in the cystic duct could be defined as the Mirizzi syndrome, a rare complication. Inexperienced coders would just code the jaundice to R17, unspecified jaundice.

Duodenitis is inflammation of the duodenum, the first portion of the small intestine. The duodenum is a tube around a foot long. Its near end connects to the stomach; the duodenum’s far end blends into the rest of the small intestine.

Duodenitis can only be diagnosed with a tissue biopsy, which is performed using endoscopy (esophagogastroduodenoscopy). Hence, Biopsy or endoscopy are common ways of recording diagnosis, which means the Health Information Management (HIM) / Medical Records (MR) practitioner must read the contents of the medical record to derive at a more decisive ICD-10 code.  Some of you must have known the diagnosis Crohn’s disease –  an inflammatory condition that can cause duodenitis,:recorded as the principal diagnosis in medical records. If you are certain that duodenitis is the reason for the endoscopy, then use ICD-10 code K29.8, otherwise just code Crohn’s disease.

The shape of the pancreas is like a tadpole, the pancreas can be affected in its head (the rightmost portion that lies adjacent to the duodenum), body (the middle portion of the pancreas), tail (the leftmost portion of the pancreas that lies adjacent to the spleen) parts, and the ducts that lead away from the pancreas.

Most people have just one pancreatic duct. The pancreatic duct (functional), or duct of Wirsung (also referred as the Major pancreatic duct), is a duct joining the pancreas to the common bile duct to supply pancreatic juices which aid in digestion. The pancreatic duct joins the common bile duct just prior to the ampulla of Vater, after which both ducts perforate the medial side of the second portion of the duodenum. However, some people have an additional accessory pancreatic duct also called the Duct of Santorini (non-functional), which connects straight to the duodenum, bypassing the Ampulla of Vater.

Compression, obstruction or inflammation of the pancreatic duct may lead to acute pancreatitis. The most common cause for this obstruction is choledocholithiasis, or gallstones in the common hepatic duct. ICD-10 Code K80.5 is the correct code for choledocholithiasis. Obstruction can also be due to duodenal inflammation in Crohn’s Disease. A gallstone may get lodged in the constricted distal end of the ampulla of Vater, where it blocks the flow of both bile and pancreatic juice into the duodenum. Bile backing up into the pancreatic duct may initiate pancreatitis. Calculus of pancreas is the condition when a gallstone may get lodged in the pancreatic duct. ICD-10 Code K86.8 is used for this condition.

Sometimes doctors will record the discharge diagnosis as ERCP, short for Endoscopic Retrograde Cholangiopancreatography, which is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the surgeon can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays. ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones. Since procedure coding is yet to be implemented in most hospitals in Malaysia,  I like to suggest that Health Information Management (HIM) / Medical Records (MR) practitioners must read the medical record to determine the right ICD-10 to use. Is the patient suffering from acute pancreatitis or chronic pancreatitis, or a disease of biliary tract, unspecified and the ERCP done for diagnostic purposes. I think in this instance it is best to code this case as K83.9 for disease of biliary tract, unspecified.

Fibrosis of pancreas (K86.8) is a specified disease of the pancreas.caused by such processes as necrosis (a form of cell injury that results in the premature death of cells in living tissue), inflammation or duct obstruction, in this instance the accessory pancreatic duct due to chronic pancreatitis.

Malignant neoplasm (cancer) may affect the head of pancreas, acute pancreatitis may be caused by the middle pancreas, and malignant neoplasm (cancer) may also affect the tail of pancreas. ICD-10 C25.0 is used to code malignant neoplasm of the head of pancreas, ICD-10 C25.2 is used to code malignant neoplasm of the tail of pancreas, and ICD-10 K85 is used to code acute pancreatitis causes by the middle pancreas. Do remember to refer to Chapter IV (appropriate codes in this chapter, i.e. E05.8, E07.0, E16-E31, E34.-) that may be used, if desired, as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere. For those wishing to identify the histological type of neoplasm, then provide the separate morphology codes from the section Morphology of neoplasms..

Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food. Cholangitis is usually caused by a bacterial infection, which can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver. Use ICD-10 Code K83.0 for Cholangitis affecting the bile duct. You may need to code the infection as well.

Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine. Either or both of the left and right hepatic ducts can be affected. If the obstruction is not due to calculus, then the ICD-10 code K83.1 must be used. The presence of gall stones in these ducts requires the use of the ICD-10 codes K80.3, K80.4 and K80.5

Do exercise caution when applying these codes (K80.3, K80.4 and K80.5) when cholelithiasis, or gallstones, a common syndrome in which hard stones composed of cholesterol or bile pigments form in the gallbladder is also reported.

References:

1. Nicki, RC, Brian, RW & Stuart, HR 2010, Davidson’s Principles and Practice of Medicine, 21 edn, Churchill Livingstone Elsevier, Elsevier Health Sciences, Beijing, P.R. China
2. William, DC 2010, Current clinical medicine, 2nd edn, Saunders Elsevier, Philadelphia, PA, USA
3. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland