September 4, 2006

Coding for Pancreatitis
For The Record
Vol. 18 No. 18 P. 37

Pancreatitis is an inflammation of the pancreas that occurs when the digestive enzymes begin to digest cells in the pancreas instead of the duodenum. A majority of all pancreatitis cases are caused by heavy alcohol use and gallstones. Other causes of pancreatitis include certain medical conditions, some medications such as corticosterioids, genetic mutations, and increased blood-fat levels. Eating a high-fat diet can raise the blood-fat levels and increase the risk of gallstones.

Pancreatitis can be classified as acute or chronic. Acute pancreatitis appears suddenly and usually lasts a few days. Assigned to ICD-9-CM code 577.0, acute pancreatitis may be mild to life-threatening. Code 577.0 also includes pancreatitis documented as the following:

• annular;

• apoplectic;

• calcareous;

• gangrenous;

• hemorrhagic;

• acute interstitial;

• malignant;

• subacute;

• suppurative; and

• unspecified.

Code 577.0 also identifies pancreatic abscess and pancreatic necrosis.

Chronic pancreatitis (577.1) develops gradually and persists over many years. Code 577.1 also includes pancreatitis documented as the following:

• chronic interstitial;

• painless;

• recurrent; and

• relapsing.

Other types of pancreatitis include the following:

• cystic pancreatitis (577.2);

• fibrous pancreatitis (577.8);

• mumps pancreatitis (072.3); and

• syphilitic pancreatitis (095.8).

Gallstone pancreatitis is a common diagnosis documented by physicians in the medical record. The gallstones block the flow of pancreatitic juices into the duodenum. Specific code assignment will depend on the individual record, location of the gallstone (category 574), and the type of pancreatitis (code 577.0 or 577.1) present. Sequencing will depend on the circumstances of admission. Review the medical record to determine the reason for admission and sequence that condition as the principal diagnosis. Do not assume there is an obstruction in the bile duct unless it is documented by the physician (AHA Coding Clinic for ICD-9-CM, 1996, second quarter, pages 13-15).

Symptoms
The following are common signs and symptoms for both acute and chronic pancreatitis:

• mild to severe steady abdominal pain;

• nausea;

• vomiting; and

• fever.

The following symptoms are typically present in acute pancreatitis:

• rapid pulse;

• swollen, tender abdomen;

• dehydration;

• decreased blood pressure;

• ascites;

• ileus;

• whites of eyes become yellow; and

• internal bleeding and shock in severe cases.

Symptoms characteristic of chronic pancreatitis include the following:

• bloating;

• gas;

• weight loss;

• oily, malodorous stools; and

• diabetes.

Diagnosis
To confirm a diagnosis of acute pancreatitis, physicians may order blood tests to look for the following:

• elevated amylase;

• elevated lipase;

• increased white blood cell count;

• elevated liver enzymes;

• increased bilirubin;

• hyperglycemia; and

• hypocalcemia.

In addition, the physician may order the following:

• ultrasound to determine the presence of gallstones in the gallbladder or common bile duct;

• computed tomography of abdomen to detect change in size of pancreas; or

• endoscopic retrograde cholangiopancreatography (ERCP; 51.10) or endoscopic retrograde cholangiography (51.11) to identify stones in common bile duct and remove them (51.88).

Chronic pancreatitis is more difficult to diagnose because some tests may return negative results even though the condition is present. The physician may order the following tests to aid in the diagnosis of chronic pancreatitis:

• blood tests;

• stool tests to measure the fat content in feces;

• ultrasound;

• ERCP; and

• pancreatic function test to measure the ability of the pancreas to secrete enzymes or other substances necessary for digestion.

Treatment
The main goal for treating pancreatitis is to control the pain and allow the pancreas to rest by placing the patient on intravenous fluids and nutrients. The patient will also be treated for any complications that may have occurred. Common complications of acute pancreatitis include the following:

• infection of pancreas (577.0);

• pseudocysts (577.2);

• abscess (577.0);

• respiratory failure (518.81); and

• shock (785.50).

Complications of chronic pancreatitis include bleeding from blood vessels, malnutrition, weight loss, diabetes mellitus, drug addiction, and pancreatic cancer.

Coding and sequencing for pancreatitis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

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