As we are all aware, coding is not a science.
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In short, Coding Clinic says the correct code assignment depends on the individual medical record documentation and sequencing depends on the circumstances of admission. Since no common bile duct stones were found, assign code 574.1x, Calculus of gallstone with other cholecystitis. Is 574.51, Calculus of the bile duct without mention of cholecysititis, with obstruction, always used for gallstone pancreatitis?ĭo not assume a bile duct obstruction for gallstone pancreatitis. The pathology report identifies chronic cholecystitis and cholelithiasis.
Sequencing depends upon the circumstances of the admission.Ī patient undergoes cholecystectomy for gallstone pancreatitis. If a patient has gallstone pancreatitis and documented acute cholecystitis and/or cholelithiasis, would this be the principal diagnosis over the pancreatitis? The following questions and answers are from Coding Clinic Second Quarter 1996 pg. There are also some coders that believe that if surgical intervention is performed at any time during the stay then the calculus should be assigned as the principal diagnosis. There are some coders and auditors that seem to be of the opinion that acute pancreatitis is always the more serious condition and always the focus of treatment. This often results in coders applying the “two conditions equally meeting the definition of the principal diagnosis” guideline. This makes it extremely difficult for some coders to mentally separate the two and think of treatment being directed at one over the other. It is the reason for admission, the pre- and post-operative diagnosis, and the discharge diagnosis. Even though coding the condition results in two codes, the physician is documenting “gallstone pancreatitis” throughout the record. There are varied schools of thoughts about the sequencing of the codes related to this condition. Depending on the patient’s condition, surgery will either take place immediately or after several days of treatment to allow the inflammation to subside first. In more severe cases, surgical intervention is required to remove the gallstone. Typical treatment includes: no oral intake, IV fluids and pain medications in the hospital. Treatment depends on the severity of the condition. It can be a life-threatening disease that requires urgent evaluation by a physician. What exactly is gallstone pancreatitis? Gallstone pancreatitis is inflammation of the pancreas that results from blockage of the pancreas duct by a gallstone. While code assignment for this condition is straightforward, determining which of the two codes to assign as the principal diagnosis can be challenging. One code for the pancreatitis and one code for the calculus of the gallbladder or biliary passages.
As you know, coding this condition requires two codes. Tune in to this monthly online coding column, facilitated by AHIMA’s coding experts, to learn about challenging areas and documentation opportunities for ICD-10-CM/PCS.Īfter all these years, gallstone pancreatitis still appears to be a favorite topic for RAC audits.
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