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Anatomy and
Pathophysiology
for
ICD-10
2014
Module 6
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ICD-10 Experts
Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC, COBGC
VP, ICD-10 Training and Education
Shelly Cronin, CPC, CPMA, CPC-I, CANPC, CGSC, CGIC, CPPM
Director, ICD-10 Training
Betty Hovey, CPC, CPMA, CPC-I, CPC-H, CPB, CPCD
Director, ICD-10 Development and Training
Jackie Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC
Director, ICD-10 Development and Training
Peggy Stilley, CPC, CPB, CPMA, CPC-I, COBGC
Director, ICD-10 Development and Training
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Revised 111213. All rights reserved.
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Contents
Module 6
Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
General Structure and Function of the Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Specialized Epithelial Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Diseases, Disorders, Injuries, and Other Conditions of the Digestive System . . . . . . . . . . . . . . . . . . . 5
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Module
Digestive System
6
Terminology
Anastomosis—A surgical connection between two
hollow, tubular structures.
Alimentary—Concerning food, nourishment, and the
organs of digestion.
Bile—A bitter, yellow-green secretion of the liver.
Cecum—First portion of the large intestine situated in
the lower right quadrant of the abdomen.
Colon—Part of the large intestine running from the
cecum to the rectum assisting in food digestion and
waste removal in the body.
Colostomy—A surgical procedure in which one end of
the large intestine is brought out through the abdominal
wall where stool is collected in a bag attached to the
abdomen.
Duodenum—The first part of the small intestine
extending from the pylorus (at the bottom of the
stomach) to the jejunum.
Dyskinesia—Difficulty or distortion in performing
voluntary movements.
Dysplasia—Abnormal growth or development of cells
or organs.
Enterostomy—A surgical procedure in which one end
of the small intestine is brought out through the abdominal wall where stool is collected in a bag attached to the
abdomen.
Esophagostomy—Surgical creation of an artificial
opening into the esophagus to allow for nutritional
support.
Gastrostomy—Surgical creation of an artificial opening
into the stomach to allow for nutritional support.
Hemorrhage—Bleeding or abnormal flow of blood.
© 2013 AAPC. All rights reserved. 111213
Ileum—Lowest part of small intestine continuing from
the jejunum, located just before the large intestine.
Jejunum—Part of the small intestine located between
the duodenum and ileum.
Malabsorption—Impaired absorption of nutrient of
food by the intestines.
Mastication—Chewing, tearing, or grinding food with
teeth as it is mixed with saliva.
Perforation—A hole that develops through the entire wall
of the stomach, small or large intestine, or gallbladder.
Pyloric sphincter—A muscular ring in the stomach
that controls passage of food from the stomach into the
duodenum.
Introduction
The digestive system is made up of the gastrointestinal
tract (GI tract), also known as the alimentary canal.
The mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anus all make up the
digestive tract, which is basically a food-processing pipe
about 30 ft. long. Associated digestive structures include
three pairs of salivary glands, the pancreas, the liver,
and the gallbladder, each with a very important role.
The appendix—a short, blind-ended tube attached to the
large intestine—has no known function. Food is moved
through the digestive tract by muscular contractions
called peristalsis until it is eliminated from the body.
The primary function of the digestive system is to break
down the food we eat into smaller parts so the body can
use it to build and nourish cells and provide energy. This
process is carried out by:
• Ingesting food
• The body propels the food through the GI tract
from mouth to anus
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Digestive System
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• Mucus, water, enzymes, and other digestive
substances are secreted to break the food down
• Food particles are mechanically and chemically
digested into absorbable nutrients
• Digested particles are absorbed
• Waste products are eliminated from the body
through defecation
Food enters the digestive system through the mouth
and is cut, crushed, and ground by teeth. The muscular
tongue moves the food around in the mouth. As food is
swallowed it moves down the pharynx (throat), where
salivary glands secrete saliva, which contains enzymes
to start digestion. It continues to be propelled through
the esophagus and into the stomach. The stomach is
a J-shaped muscular bag that adds gastric acids while
it churns, digests, and stores food. The food becomes
liquefied to enter the small intestine where additional
chemical secretions from the pancreas, liver, and gallbladder are added to digest the food into absorbable
nutrients. The walls of the small intestines absorb the
nutrients while unused waste products move into the
colon, or large intestine where fluid is removed. Waste
then becomes solid and is defecated through the anus.
General Structure and
Function of the Digestive System
Remarkably diverse and specialized processes take place
in different sections of the digestive tract, but there is
a fundamental consistency in the architecture of the
tubular digestive tract. From the mouth to the anus,
the wall of the digestive tube is composed of four basic
layers or tunics. The layers vary in thickness and tissue/
cell type (connective, muscle, and epithelial). They have
sublayers and contain other functional structures, such
as glands, blood and lymph vessels, and nerve fibers.
Beginning with the innermost layer, the four layers of
the digestive tube are the:
•
•
•
•
2
Mucosa
Submucosa
Muscularis
Serosa
Anatomy and Pathophysiology for ICD-10
Source: AAPC
The mucosa is the innermost layer of tissue lining the
GI tract. It contains three sublayers: mucous epithelium,
lamina propria, and muscularis mucosae. Certain cells
in the mucosa secrete mucus, digestive enzymes, and
hormones. Ducts from other glands pass through the
mucosa to the lumen. In the mouth and anus, where
thickness for protection against abrasion is needed, the
epithelium is stratified squamous tissue. The stomach
and intestines have a thin simple columnar epithelial
layer for secretion and absorption.
The submucosa is a thick layer of loose connective tissue
that surrounds the mucosa. This layer also contains
blood vessels, lymphatic vessels, and nerves. Glands may
be embedded in this layer.
Above the diaphragm, the outermost layer of the GI
tract is a connective tissue called adventitia. Below the
diaphragm, it is called serosa.
Specialized Epithelial Cells
The digestive system contains a number of highly
specialized cell types, each of which has very specific
functions. Epithelial cells line the inner surface of the
stomach, and secrete about 2 liters of gastric juices per
day. Gastric juice contains hydrochloric acid, pepsinogen, and mucus, which are important digestive ingredients. Secretions are controlled by nervous (smells,
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Digestive System
thoughts, and caffeine) and endocrine signals. Most of
the cells carrying out
the functions
of the GI system are
Digestive
Tract
specialized epithelial cells.
Oral cavity
Pharynx
Esophagus
Stomach
Liver
Duodenum
Gallbladder
Ascending
colon
Ileum
Site of
ileocecal
valve
Transverse
colon
Descending
colon
Jejunum
Cecum
Appendix
Sigmoid
colon
Rectum
Anal canal
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Organ Function in
the Digestive System
The digestive system has the unique function of turning
food into energy needed for survival and removing
unused products for waste disposal. They work together
in a very complex way and consist of the mouth (oral
cavity), the esophagus, the stomach, the small and large
intestines, and the accessory organs of digestion: the
liver, gallbladder, and exocrine pancreas.
The mouth is the beginning of the digestive tract; and,
in fact, digestion starts here when taking the first bite of
food. Chewing breaks the food into pieces that are more
© 2013 AAPC. All rights reserved. 111213
easily digested, while saliva mixes with food to begin
the process of breaking it down into a form your body
can absorb and use. The tongue, salivary glands, and
the teeth are critical to the digestion process in the oral
cavity. Taste buds are clusters of cells on the tongue that
respond to food by initiating secretion of saliva (up to
one liter each day) and gastric acid.
The esophagus, which is located in your throat near the
trachea, receives food from your mouth when it is swallowed. Each end the esophagus is opened and closed by
a sphincter. The upper esophageal sphincter prevents
air from entering the esophagus during respiration.
Normally, the lower esophageal sphincter closes after
food enters the stomach; however, if it fails to close or
remains closed, gastric juices may flow back into the
esophagus, causing gastroesophageal reflux. Rhythmic
contractions occur, called peristalsis, to propel liquids
and solids through the esophagus to the stomach.
The stomach is a hollow organ, or “container,” that holds
food while it is being mixed with enzymes that continue
the process of breaking down food into a usable form,
called chyme. It has three major parts: the fundus,
which is the upper rounded portion of the stomach, the
body, which is the central part of the stomach, and the
pylorus, which is the lower tubular part of the stomach.
Cells in the lining of the stomach secrete strong acid
and powerful enzymes that are responsible for the
breakdown process. When the contents of the stomach
are sufficiently processed, they are released into the
small intestine. Gastric juices are composed of digestive
enzymes and hydrochloric acid. A thick mucus layer
coats the mucosa and helps keep the acidic digestive
juice from dissolving the tissue of the stomach itself.
The small intestine is made up of three segments—the
duodenum, jejunum, and ileum—the small intestine is a
22-foot long muscular tube that breaks down food using
enzymes released by the pancreas and bile from the liver.
Peristalsis also is at work in this organ, moving food
through and mixing it with digestive secretions from the
pancreas and liver. The duodenum is largely responsible
for the continuous breaking-down process, with the
jejunum and ileum mainly responsible for absorption of
nutrients into the bloodstream.
Contents of the small intestine start out semi-solid, and
end in a liquid form after passing through the organ.
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Digestive System
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Water, bile, enzymes, and mucous contribute to the
change in consistency. Once the nutrients have been
absorbed and the leftover-food residue liquid has passed
through the small intestine, it then moves on to the large
intestine, or colon.
The pancreas secretes digestive enzymes into the
duodenum, the first segment of the small intestine.
These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting
it directly into the bloodstream. Insulin is the chief
hormone for metabolizing sugar.
The liver has multiple functions, but its main function
within the digestive system is to process the nutrients
absorbed from the small intestine. Bile from the liver is
stored in the gallbladder in between meals. At mealtime,
it is squeezed out of the gallbladder, through the bile
ducts, and into the intestine to mix with the fat in food.
The bile acids dissolve fat into the watery contents of
the intestine, which are digested by enzymes from the
pancreas, and the lining of the intestine. In addition, the
liver is the body’s chemical “factory.” It takes the raw
materials absorbed by the intestine and makes all the
various chemicals the body needs to function. The liver
also detoxifies potentially harmful chemicals. It breaks
down and secretes many drugs.
The colon (or large intestine) is a 6-foot long muscular
tube that connects the small intestine to the rectum. The
large intestine is made up of the cecum, the ascending
(right) colon, the transverse (across) colon, the
descending (left) colon, and the sigmoid colon, which
connects to the rectum. The appendix is a small tube
attached to the cecum. The large intestine is a highly
specialized organ that is responsible for processing waste
so that emptying the bowels is easy and convenient.
Hepatic
Transverse colon
Splenic
Descending
Ascending colon
colon
Sigmoid
10 %
15%
Appendix
Rectum
Sigmoid
colon
5%
50%
20 %
Anatomical distribution
of large bowel cancers
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Stool, or waste left over from the digestive process, is
passed through the colon by means of peristalsis, first
in a liquid state and ultimately in a solid form. As stool
passes through the colon, water is removed. Stool is
stored in the sigmoid (S-shaped) colon until a “mass
movement” empties it into the rectum once or twice
a day. It normally takes about 36 hours for stool to get
through the colon. The stool itself is mostly food debris
and bacteria. These bacteria perform several useful functions, such as synthesizing various vitamins, processing
waste products and food particles, and protecting
against harmful bacteria. When the descending colon
becomes full of stool, or feces, it empties its contents into
the rectum to begin the process of elimination.
The rectum is an 8-inch chamber that connects the
colon to the anus. It is the rectum’s job to receive stool
from the colon, to let the person know that there is stool
to be evacuated, and to hold the stool until evacuation
happens. When anything (gas or stool) comes into the
rectum, sensors send a message to the brain. The brain
then decides if the rectal contents can be released or not.
If they can, the sphincters relax and the rectum contracts,
disposing its contents. If the contents cannot be disposed,
the sphincter contracts and the rectum accommodates so
that the sensation temporarily goes away.
The anus is the final part of the digestive tract. It is
a two-inch long canal consisting of the pelvic floor
muscles and the two anal sphincters (internal and
external). The lining of the upper anus is specialized
to detect rectal contents. It lets you know whether the
contents are liquid, gas, or solid. Sphincter muscles that
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Module 6
Digestive System
are important in allowing control of stool surround the
anus. The pelvic floor muscle creates an angle between
the rectum and the anus that stops stool from coming
out when it is not supposed to. The internal sphincter
is always tight, except when stool enters the rectum.
It keeps us continent when we are asleep or otherwise
unaware of the presence of stool. When we get an urge
to go to the bathroom, we rely on our external sphincter
to hold the stool until reaching a toilet, where it then
relaxes to release the contents.
Diverticulum of esophagus, acquired
gastro-esophageal laceration-hemorrhage
syndrome
Barrett’s esophagus without dyspla-sia
Barrett’s esophagus with low grade
dysplasia
Barrett’s esophagus with high grade
dysplasia
Barrett’s esophagus with dysplasia,
unspecified
Other specified diseases of the eso-phagus
Diseases of esophagus, unspecified
Disorders of esophagus in diseases classified elsewhere
Diseases, Disorders,
Injuries, and Other
Conditions of the Digestive System
Esophageal Disorders
A very common disorder that can affect the esophagus
is Gastroesophageal Reflux Disease (GERD), which is
caused by weakness of the lower esophageal sphincter.
Stomach acid is normally removed from the esophagus
through the process of peristalsis, squeezing movements
to push acid into the stomach. The sphincter may not
close tightly enough or may relax too much during the
course of the day or at night causing the backflow of acid
and bile found in the stomach to aide in the digestion
process. Barrett’s esophagus is a condition in which the
lining of the esophagus is damaged, most commonly
found in patients with GERD due to chronic inflammation of the esophagus. A diagnosis of Barrett’s esophagus may be concerning because it increases the risk of a
patient developing esophageal cancer.
K22.5
K22.6
K22.70
K22.710
K22.711
K22.719
K22.8
K22.9
K23
Stomach and Duodenal Ulcers
Ulcers are open sores or lesions. They are found in the
skin or mucous membranes of areas of the body. A
stomach ulcer is called a gastric ulcer and an ulcer in the
duodenum is called a duodenal ulcer. Lifestyle, stress and
diet used to be thought to cause ulcers. These factors may
have a role in ulcer formation; however, they are not the
main cause of them. Scientists now know that ulcers are
caused by hydrochloric acid and pepsin that are contained
in our stomach and duodenal parts of our digestive
system and that these acids contribute to ulcer formation.
The ICD-10-CM code range for stomach and duodenal
ulcers is K25.0–K28.9.
The ICD-10-CM code range for disorders of the esophagus is K20.0–K23
Eosinophilic esophagitis
Other esophagitis
Esophagitis, unspecified
Achalasia of cardia
Ulcer of esophagus without bleeding
Ulcer of esophagus with bleeding
Esophageal obstruction
Perforation of esophagus
Dyskinesia of esophagus
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K20.0
K20.8
K20.9
K22.0
K22.10
K22.11
K22.2
K22.3
K22.4
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Digestive System
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Chronic or unspecified gastric ulcer with
perforation
K25.5
Chronic or unspecified gastric ulcer with
both hemorrhage and perforation
K25.6
Chronic or unspecified gastric ulcer
without hemorrhage or perforation
K25.7
Gastric ulcer, unspecified as acute
or chronic, without hemorrhage or
perforation
K25.9
Currently there are no ICD-10-CM guidelines
specifically related to this condition.
Source: AAPC
Knotted
intestine
(volvulus)
The following information is required to code for these
types of ulcers:
•
•
•
•
•
Acute or chronic condition
Hemorrhage
Perforation
Hemorrhage with perforation
Without hemorrhage or perforation
Diverticulum
Acute gastric ulcer with hemorrhage
K25.0
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Acute gastric ulcer with perforation
K25.1
Diverticulitis and Diverticulosis
Acute gastric ulcer with both hemorrhage
K25.2
and perforation
6
Acute gastric ulcer without hemorrhage
or perforation
K25.3
Chronic or unspecified gastric ulcer with
hemorrhage
K25.4
Anatomy and Pathophysiology for ICD-10
Pressure within the colon causes bulging pockets of
tissue (sacs) that push out from the colonic walls as a
person ages. A small bulging sac pushing outward from
the colon wall is called a diverticulum. More than one
bulging sac is referred to in the plural as diverticula.
Diverticula can occur throughout the colon but are
most common near the end of the left colon referred
to as the sigmoid colon. The condition of having these
diverticula in the colon is called diverticulosis, which
is a very common condition. It is found in more than
half of Americans over age 60. Only a small percentage
of these people will develop the complication of
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Module 6
Digestive System
diverticulitis. Inflammation or a small tear in a diverticulum causes diverticulitis. If the tear is large, stool in
the colon can spill into the abdominal cavity, causing
an infection or abscess in the abdomen. Symptoms
include abdominal pain, chills, fever, nausea, vomiting,
or weight loss. Eating foods high in fiber can reduce the
risk for this condition.
The ICD-10-CM code range for Diverticulitis and Diverticulosis is K57.00–K57.93.
The following information is required to code for this
these conditions:
Diverticulitis of small intestine with perforation and abscess
K57.0
Diverticulitis of small intestine with perforation and abscess without bleeding
K57.00
Diverticulitis of small intestine with perforation and abscess with bleeding
K57.01
Diverticular disease of small intestine
without perforation or abscess
K57.1
Diverticulosis of small intestine without
perforation or abscess without bleeding
K57.10
Diverticulosis of small intestine without
perforation or abscess with bleeding
K57.11
Diverticulitis of small intestine without
perforation or abscess without bleeding
K57.12
Diverticulitis of small intestine without
perforation or abscess with bleeding
K57.13
Diverticular disease of large intestine
without perforation or abscess
K57.3
111213
K57.30
Diverticulosis of large intestine without
perforation or abscess with bleeding
K57.31
Diverticulitis of large intestine without
perforation or abscess without bleeding
K57.32
Diverticulitis of large intestine without
perforation or abscess without bleeding
K57.33
In the table, the information that is necessary in the
documentation is shown. Indication of where the disease
or inflammation is located as well as if perforation or
abscess, and if bleeding is present is vital in coding
diverticulitis or diverticulosis.
• Site of inflammation or disease
• Perforation or abscess
• If bleeding is present
© 2013 AAPC. All rights reserved. Diverticulosis of large intestine without
perforation or abscess without bleeding
Direct
inguinal
hernia
(between
deep inferior
epigastric
vessels and
rectus fascia)
Incarcerated
hernia
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Hernias
A hernia is the protrusion of an organ or the fascia of
an organ through the wall of the cavity that normally
contains it. A hiatal hernia occurs when the stomach
protrudes into the mediastinum through the esophageal
opening in the diaphragm.
By far the most common hernias develop in the
abdomen, when a weakness in the abdominal wall
evolves into a localized hole, or “defect”, through which
fatty tissue, or abdominal organs covered with peritoneum, may protrude. Hernias may or may not present
either with pain at the site, a visible or palpable lump, or
in some cases by more vague symptoms resulting from
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Digestive System
Module 6
pressure on an organ which has become “stuck” in the
hernia, sometimes leading to organ dysfunction. Fatty
tissue usually enters a hernia first, but it may be followed
by or accompanied by an organ. Most of the time,
hernias develop when pressure in the compartment of
the residing organ is increased, and the boundary is
weak or weakened.
Many conditions chronically increase intra-abdominal
pressure, (pregnancy, ascites, COPD, dyschezia, benign
prostatic hypertrophy) and explain why abdominal
hernias are very common.
The ICD-10-CM code range for hernias is K40.00–K46.9.
The following information is required to code for these
conditions:
•
•
•
•
Site of hernia
Laterality, when appropriate
If gangrene or obstruction is present
If condition is recurrent
Bilateral inguinal hernia, with obstruction,
K40.00
without gangrene, not specified as recurrent
Bilateral inguinal hernia, with obstruction,
without gangrene, recurrent
K40.01
Unilateral inguinal hernia, with obstruction,
K40.30
without gangrene, not specified as recurrent
Unilateral inguinal hernia, with
obstruction, without gangrene, recurrent
K40.31
Bilateral inguinal hernia with gangrene,
not specified as recurrent
K40.10
Bilateral inguinal hernia with gangrene,
recurrent
K40.11
Unilateral inguinal hernia, with gangrene,
not specified as recurrent
K40.40
Unilateral inguinal hernia, with gangrene,
recurrent
K40.41
Bilateral inguinal hernia, without
obstruction or gangrene, not specified as
recurrent
K40.20
Bilateral inguinal hernia, without
obstruction or gangrene, recurrent
K40.21
Unilateral inguinal hernia, without
obstruction or gangrene, not specified as
recurrent
K40.90
Unilateral inguinal hernia, without
obstruction or gangrene, recurrent
K40.91
In the table above, the laterality is shown (as appropriate
depending on the hernia). The fourth digits indicate the
presence of an obstruction or gangrene, while the fifth
digits indicate if the condition is specified as recurrent
or not.
The guidelines that precede this section in the tabular
area indicate that a hernia with both gangrene and
obstruction is classified to hernia with gangrene.
Right and left
bile ducts
Right hepatic artery
Cystic artery
Gallstone
in fundus
Cystic
duct
Hartmann’s
pouch
(infundibulum)
Triangle of
Calot
Common
hepatic
artery
Portal
vein
Common
bile duct
empties
into
Duodenum
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Digestive System
Cholelithiasis
Cholelithiasis is the presence of one or more calculi
(gallstone) in the gallbladder. Gallstones are hard,
pebble-like deposits that form inside the gallbladder.
They may be as small as a grain of sand or as large as a
golf ball. Failure of the gallbladder to empty bile properly (likely to happen during pregnancy), and medical
conditions that causes the liver to make too much bilirubin can commonly cause one to develop gallstones.
The most common types of gallstones are the ones made
out of cholesterol, which has nothing to do with the
cholesterol levels in the blood.
Choledocholithiasis occurs if a large stone blocks
either the cystic duct or the common bile duct causing
cramping pain in the middle to right upper abdomen.
The pain is relieved if the stone passes into the first part
of the small intestine (the duodenum). Other possible
symptoms may include fever, yellowing of skin and
whites of eyes (jaundice), abdominal fullness, claycolored stools, and nausea and vomiting.
Cholangitis is an infection of the common bile duct, the
tube that carries bile from the liver to the gallbladder
and intestines. It is usually caused by a bacterial infection, which can occur when from blockage of the duct,
such as a gallstone or tumor.
The ICD-10-CM code range for disorders of gallbladder,
biliary tract and pancreas is K80.00–K87.
The following information is required to code for these
conditions:
• Site
• Acute or chronic
• With or without obstruction
Calculus of gallbladder with acute
cholecystitis without obstruction
K80.00
Calculus of gallbladder with acute
cholecystitis with obstruction
K80.01
Calculus of gallbladder with chronic
cholecystitis without obstruction
K80.10
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Calculus of gallbladder with chronic
cholecystitis with obstruction
K80.11
Calculus of gallbladder with acute and
chronic cholecystitis without obstruction
K80.12
Calculus of gallbladder with acute and
chronic cholecystitis with obstruction
K80.13
Calculus of gallbladder with other
cholecystitis without obstruction
K80.18
Calculus of gallbladder with other
cholecystitis with obstruction
K80.19
Calculus of the bile duct with cholangitis,
unspecified, without obstruction
K80.30
Calculus of the bile duct with cholangitis,
unspecified, with obstruction
K80.31
Calculus of the bile duct with acute
cholangitis, without obstruction
K80.32
Calculus of the bile duct with acute
cholangitis with obstruction
K80.33
Calculus of the bile duct with chronic
cholangitis without obstruction
K80.34
Calculus of the bile duct with chronic
cholangitis with obstruction
K80.35
Calculus of the bile duct with acute and
chronic cholangitis without obstruction
K80.36
Calculus of the bile duct with acute and
chronic cholangitis with obstruction
K80.37
The table above demonstrates the importance of
specifying if the condition is acute or chronic, and
where the stones are located, as well as if there is an
obstruction present.
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Digestive System
Module 6
Intraoperative and
postprocedural complications
Complications of procedures performed on the digestive system codes are found in the digestive chapter. The
codes in ICD-10-CM for complications of surgery on
the digestive system are found in categories K91–K94.39.
They are classified as “intraoperative” and “postprocedural”, and additional information will need to be
obtained if it is not documented in the note. Some of
these complications include obstruction, hemorrhage,
hematoma, and infection. In patients who have had
gastric bypass surgery some of the complications may
also include vomiting, dumping syndrome, and postsurgical malabsorption. Dumping syndrome occurs
when the patient eats foods rich in sugar content and
the body floods the intestines in an attempt to dilute
the sugar. The patient may experience a rapid and
forceful heart rate and anxiety as well as nausea, which
may also be followed by diarrhea. Due to the fact that
gastric bypass surgery reduces the amount of food that
the stomach can store, it is very important for these
patients to ensure that the food they ingest provides a
good balance of nutrition. Not only does their intake
amount decline, but also the rate at which their bodies
absorb the food. The number of acid producing cells in
the lining of the stomach increase after bypass surgery
so the physician may recommend use of acid reducing
medications, which may then cause a condition known
as achlorhydria (not enough acid in the stomach). With
such low levels of acidity in the stomach, patients are at
risk of developing overgrowth of bacteria in the stomach
causing nausea and vomiting. Extended symptoms of
nausea and vomiting will lead to malnutrition so the
physician must closely monitor the level of acidity in the
stomach and the patient must work closely with a dietitian to ensure a well-balanced intake of foods.
The ICD-10-CM code range for Intraoperative and
postprocedural complications is K91.0–K94.39.
The following information is required to code for these
conditions:
• Intraoperative or postprocedural complication
• Type of complication
• Type of procedure performed
10
Anatomy and Pathophysiology for ICD-10
Vomiting following gastrointestinal surgery
Postgastric surgery syndromes
Postsurgical malabsorption, not elsewhere
classified
Postprocedural intestinal obstruction
Postcholecystectomy syndrome
Intraoperative hemorrhage and hematoma
of a digestive system organ or structure
complicating a digestive system procedure
Intraoperative hemorrhage and hematoma
of a digestive system organ or structure
complicating other procedure
Accidental puncture and laceration of a
digestive system organ or structure during a
digestive system procedure
Accidental puncture and laceration of a
digestive system organ or structure during a
digestive system procedure
Other intraoperative complications of
digestive system
Postprocedural hepatic failure
Postprocedureal hepatorenal syndrome
Postprocedural hemorrhage and hematoma
of a digestive system organ or structure
following a digestive system procedure
Postprocedural hemorrhage and hematoma
of a digestive system organ or structure
following other procedure
Pouchitis
Other complications of intestinal pouch
Other postprocedural complications and
disorders of digestive system
K91.0
K91.1
K91.2
K91.3
K91.5
K91.61
K91.62
K91.71
K91.72
K91.81
K91.82
K91.83
K91.840
K91.841
K91.850
K91.858
K91.89
Additionally, there are specific ICD-10-CM codes for
reporting complications of artificial openings of the
digestive system. These codes require the following
information:
• Type of surgery that caused the artificial opening
• Type of complication
Colostomy complication, unspecified
Colostomy hemorrhage
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K94.00
K94.01
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Module 6
Colostomy infection
Colostomy malfunction
Other complications of colostomy
Enterostomy complication, unspecified
Enterostomy hemorrhage
Enterostomy infection
Enterostomy malfunction
Other complications of enterostomy
Gastrostomy complication, unspecified
Gastrostomy hemorrhage
Gastrostomy infection
Gastrostomy malfunction
Other complications of gastrostomy
Esophagostomy complication, unspecified
Esophagostomy hemorrhage
Esophagostomy infection
Esophagostomy malfunction
Other complications of esophagostomy
Digestive System
K94.02
K94.03
K94.09
K94.10
K94.11
K94.12
K94.13
K94.19
K94.20
K94.21
K94.22
K94.23
K94.29
K94.30
K94.31
K94.32
K94.33
K94.39
When coding for an infection, ICD-10-CM instructs the
user to:
Use additional code to specify type of infection, such as:
Cellulitis of abdominal wall (L03.32)
Sepsis (A40.-, A41.-)
Sources
Comprehensive Medical Terminology (Fourth Edition) by
Betty Davis Jones.
Stedman’s Medical Dictionary, 28th edition
Bates’ Pocket Guide to Physical Examination and History
Taking, Third Edition (Lynn S. Bickley-Lippincott)
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