Crohn’s disease and ulcerative colitis are both chronic inflammatory gastrointestinal diseases. Crohn’s disease is characterized by inflammation of the digestive tract lining. Proper documentation by the physician specifying the location of Crohn’s disease, as well as any complications or manifestations, is required for proper code selection according to a medical coding service provider e.g., Crohn’s Disease ICD 10.
Symptoms can range from subtle and mild to severe and visible depending on the inflammation’s location, extent, and severity. If the inflammation spreads deep into the tissues, it can even cause intestine perforation. Despite being a chronic disease, controlling Crohn’s allows people to live a more fulfilling life. Early detection and treatment can help to avoid serious complications. A lot of the time diagnosis is made as per the specifications of the Crohn’s disease ICD 10 code.
Inflammatory Bowel Disease (IBD):
Inflammatory bowel disease (IBD) is a chronic immune-mediated digestive tract disorder in which the body incorrectly attacks the intestines. Symptoms vary depending on the location and severity of the inflamed bowel, but they typically include chronic diarrhea, which can be bloody, abdominal pain, and weight loss. Extraintestinal diseases can affect the mouth, skin, joints, liver, or eyes. IBD can have an impact on nutrition, growth, and puberty. The IBD and Crohn’s disease ICD 10 resource helps primary care clinicians care for children and adolescents with IBD.
The term IBD refers to two disease entities that can have significant clinical overlap: ulcerative colitis (UC), in which inflammation primarily affects the large intestine, and Crohn’s disease (CD), in which inflammation can affect any portion of the digestive tract from the mouth to the anus. Children with IBD who do not fit into either category (15%) are diagnosed with “indeterminate colitis” or “unclassified inflammatory bowel disease” (IBD-U).
About Crohn’s Disease:
Crohn’s disease is an inflammatory bowel disorder (IBD). It causes inflammation of the tissues in the digestive tract, which frequently spreads into the deeper layers of the bowel. Crohn’s disease can be painful and stressful, and it can sometimes lead to fatal complications.
According to the Crohn’s and Colitis Foundation of America (CCFA), up to 780,000 Americans are living with this condition.
The following are the various subtypes of Crohn’s disease and their symptoms:
- Crohn’s enteritis is an inflammation of the small intestine.
- Crohn’s disease is an inflammation of the colon.
- Crohn’s entero-colitis and ileocolitis are inflammations of the small intestine and colon.
- Crohn’s terminal ileitis is an inflammation that only affects the end of the small intestine.
The exact cause of Crohn’s disease is unknown. Diet and stress were previously suspected, but doctors now understand that these factors may aggravate, but not cause, Crohn’s disease. Its development is most likely influenced by a number of factors.
The immune system:
A virus or bacterium could cause Crohn’s disease; however, researchers have yet to identify such a trigger. When your immune system attempts to combat an invading microorganism or environmental triggers, an atypical immune response causes the immune system to attack digestive tract cells as well.
Crohn’s disease is more common in people who have a family member who has it, suggesting that genes may play a role in making people more likely to have it. However, most Crohn’s disease patients do not have a family history of the disease.
Crohn’s disease can affect any part of your small or large intestine. It may consist of multiple segments or be continuous. Some people only have the disease in the colon, which is part of the large intestine.
Crohn’s disease symptoms can range from mild to severe. They usually appear gradually, but they can also appear suddenly and without warning. There are also times when you have no signs or symptoms (remission). When the disease is active, the following symptoms are common:
- Cramping and pain in the abdomen
- Sores in your mouth and blood in your stool
- Weight loss and reduced appetite
- Inflammation from a tunnel into the skin causes pain or drainage near or around the anus (fistula)
Crohn’s disease is diagnosed through colonoscopy and radiological studies such as barium enema, upper GI series with small bowel follow-up, and CT scans of the abdomen and pelvis. The documentation through Crohn’s disease ICD 10 by the physician should clearly indicate the location of Crohn’s disease, the extent of the affected area, the severity, and any complications.
Crohn’s disease affects the small intestine, the large intestine, both the small and large intestines, and the unspecified. The intestine in Crohn’s disease is a mix of healthy and inflamed areas. Crohn’s disease affects all layers of the bowel wall.
The documentation for Crohn’s disease should clearly specify the location and extent of the affected area to ensure accurate Crohn’s disease ICD 10 code selection.
- Small intestine (duodenum, ileum, jejunum) (regional or terminal).
- Large intestine (colon, large bowel, rectum) (granulomatous colitis or regional colitis).
- Small and large intestines.
Crohn’s Disease ICD 10 Code:
Following a visit for a diagnostic study, the next and most important step is the assignment of codes (Crohn’s disease ICD 10 Code) according to the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM).
Medical necessity for the services provided is supported by these codes, and the specificity of the diagnostic code is important to the successful submission and payment of a claim. When ruling out a more serious disease/diagnosis, signs and symptoms are valid code choices because they support the medical necessity for a work-up to determine etiology.
Comorbidities that influence the provider’s decision-making should be included as additional diagnoses to support the higher level of decision-making. By including all of these details in the medical record, the medical coder before making a final selection when coding for Crohn’s disease makes sure to review the documentation for relevant details. After that, they will be able to assign the appropriate Crohn’s disease ICD 10 code (“with complications” or “without complications”).
If no complications are specified in the documentation, assign the location without complications. If the documentation does not specify whether the condition is in the small or large intestine, or if the condition is documented as regional enteritis NOS, use the unspecified code.
Coding inflammatory gastrointestinal diseases is clearly dependent on the physician’s documentation in the medical record. Medical coding companies can assist gastroenterologists in submitting error-free claims for optimal reimbursement by clearly documenting diagnosis, management, and treatment in the physician’s report.
Treatment for Crohn’s Disease ICD 10:
Medication and surgery are both used to treat Crohn’s disease. Sulfasalazine (Azulfidine), mesalamine (Asacol, Rowasa), corticosteroids, budesonide (Entocort EC), and balsalazide are some common anti-inflammatory medications (Colazal).
Azathioprine (Imuran), mercaptopurine (Purinethol), infliximab (Remicade), adalimumab (Humira), methotrexate (Rheumatrex), and cyclosporine are common immune system suppressor medications used to treat this inflammatory disease.
Metronidazole (Flagyl), ciprofloxacin (Cipro), antidiarrheals, pain relievers, iron supplements, vitamin B12 shots, and calcium and vitamin D supplements are all used to treat Crohn’s disease. If the condition is severe enough, surgery to remove the affected portion of the GI tract may be required.
Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract. Living with a chronic illness can be exhausting and stressful. More effective treatments and, possibly, a cure for Crohn’s disease are still being researched. However, symptoms can be effectively managed, and remission is possible.
Your doctor can assist you with the appropriate medications, alternative treatments, and lifestyle changes. If you are experiencing gastrointestinal symptoms, consult your doctor (gastroenterologist) to determine the cause and possible solutions.