ICD-10 Coding for Endoscopy(K25.4, D12.6, K52.9)
Complete ICD-10-CM coding and documentation guide for Endoscopy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Endoscopy
K20-K31Primary Range
Diseases of esophagus, stomach and duodenum
This range includes conditions commonly diagnosed or treated with endoscopy, such as ulcers and gastritis.
Noninfective enteritis and colitis
Covers inflammatory conditions of the intestine that may require endoscopic evaluation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| K25.4 | Chronic or unspecified gastric ulcer with hemorrhage | Use when an endoscopy confirms a bleeding gastric ulcer. |
|
| D12.6 | Benign neoplasm of colon, unspecified | Use when a colonoscopy confirms an adenomatous polyp. |
|
| K52.9 | Noninfective gastroenteritis and colitis, unspecified | Use when endoscopy shows inflammation without specific cause. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for endoscopy with biopsy
Essential facts and insights about Endoscopy
Primary ICD-10-CM Codes for endoscopy
Decision Criteria
clinical Criteria
- Documented bleeding with chronic ulcer
Applicable To
- Gastric ulcer with bleeding
Excludes
- Acute gastric ulcer (K25.0)
Clinical Validation Requirements
- Endoscopic visualization of ulcer
- Hemoglobin <12 g/dL
Code-Specific Risks
- Misclassification if bleeding is not documented
Coding Notes
- Ensure documentation specifies chronicity and bleeding.
D12.6 - Benign neoplasm of colon, unspecified
Use when a colonoscopy confirms an adenomatous polyp.
Applicable To
- Adenomatous polyp
Excludes
- Hyperplastic polyp (K63.5)
Clinical Validation Requirements
- Histology report confirming adenomatous features
Coding Notes
Ensure histological confirmation is documented.
K52.9 - Noninfective gastroenteritis and colitis, unspecified
Use when endoscopy shows inflammation without specific cause.
Applicable To
- Duodenitis
Excludes
- Infective gastroenteritis (A09)
Clinical Validation Requirements
- Biopsy showing duodenal inflammation
Coding Notes
Ensure exclusion of infectious causes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Gastrointestinal hemorrhage, unspecified
K92.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Endoscopy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code K25.4.
Impact
Clinical: Inadequate clinical information for follow-up., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use structured templates for endoscopy reports, Ensure all biopsy details are recorded
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Verify histology report before coding.
Impact
Reimbursement: Potential denial of claims., Compliance: Violation of coding standards., Data Quality: Misleading epidemiological data.
Mitigation Strategy
Confirm absence of infection before coding.
Impact
Inadequate biopsy documentation leading to audit flags.
Mitigation Strategy
Implement structured reporting templates.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Endoscopy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Endoscopy
Use these documentation templates to ensure complete and accurate documentation for Endoscopy. These templates include all required elements for proper coding and billing.
EGD with biopsy for gastric ulcer
Specialty: GastroenterologyRequired Elements
- Procedure details
- Indication for procedure
- Findings and biopsies
- Diagnosis and follow-up
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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