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Medical Codes for Gallstones – A Common Condition of the Gallbladder

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This article lists the symptoms, treatment and medical codes for gallstones, a condition wherein stone-like objects form in the gallbladder or bile ducts.

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Medical Codes for Gallstones – A Common Condition of the Gallbladder

  1. 1. www.outsourcestrategies.com 918-221-7769 Medical Codes for Gallstones – A Common Condition of the Gallbladder This article lists the symptoms, treatment and medical codes for gallstones, a condition wherein stone-like objects form in the gallbladder or bile ducts. Outsource Strategies International United States
  2. 2. www.outsourcestrategies.com 918-221-7769 Gallstones are hardened deposits of digestive fluid - usually made of cholesterol or bilirubin - that form in the gallbladder or bile duct. The gallbladder holds a digestive fluid called “bile” that's released into the small intestine. Also known as cholecystitis, these stones can form when there is a chemical imbalance in the gallbladder. These can be tiny (the size of a grain of sand), or as large as a golf ball. In certain cases, patients may develop just one gallstone, while in other cases patients may develop many gallstones at the same time. Typically, gallstones don’t cause any specific signs and symptoms and don’t need any treatment. However, if a gallstone becomes trapped in an opening (duct) inside the gallbladder, it can trigger sudden intense abdominal pain (known as biliary colic). Treatment for this condition usually involves medications (to dissolve gallstones) and in more complex cases gallbladder removal surgery (cholecystectomy). Medical billing and coding for this condition can be complex as it requires correct understanding of the rules related to the usage of codes and modifiers and payer specific guidelines. Partnering with a reliable gastroenterology medical billing company that has expert coders and billing specialists on board is a perfect strategy for providers to report and bill for this condition correctly. According to Medscape.com, about 20 million people in the United States have gallstones. Every year, in the United States, approximately 500,000 people develop symptoms or complications of gallstones requiring cholecystectomy. The exact causes of this condition are not known. However, experts opine that the condition occurs when your bile contains too much cholesterol or bilirubin and when your gallbladder doesn't empty correctly. Several factors may increase the risk of this condition such as – female gender, age, being overweight or obese, eating a diet that’s high in fat or cholesterol or low in fiber, having cirrhosis or taking medications that have high estrogen content. If left untreated, this condition can lead to
  3. 3. www.outsourcestrategies.com 918-221-7769 several complications like inflammation of the gallbladder, blockage of the common bile duct/pancreatic duct and gallbladder cancer. Types of Gallstones Generally, stones in the gallbladder may form when cholesterol, calcium bilirubinate, and calcium carbonate in the bladder are out of balance. There are two main types of gallstones -  Cholesterol gallstones – These stones form if there is too much cholesterol in the bile.  Pigment gallstones – A common problem among people with liver disease, infected bile tubes, or blood disorders. These form when the bile has too much bilirubin. Common Symptoms In most cases, this condition may not cause any specific signs and symptoms. This may be because the stones may stay in the gallbladder and cause no problems. However, if a gallstone lodges in a duct and causes a blockage, certain symptoms appear. One of the primary symptoms associated with the condition is pain that comes on suddenly and quickly gets worse. Other related symptoms include -  Stomach pain  Pain on the right-hand side of the body, just below the ribs  Back pain between the shoulder blades  Nausea or vomiting  Sweating  Restlessness  Dark urine  Burping  Indigestion
  4. 4. www.outsourcestrategies.com 918-221-7769 The pain may last for several minutes to a few hours. How Are Gallstones Diagnosed and Treated? Diagnosis of this condition may generally begin with detailed discussion between the patient and physician. The physician may ask general questions about the typical symptoms patients experience. A wide range of diagnostic imaging tests such as ultrasound and a computerized tomography (CT) scan will be performed to create images of the gallbladder and to look for possible symptoms related to this condition. Tests to check bile ducts for cholecystitis will also be conducted as part of the diagnosis. These tests use a special dye to highlight the bile ducts on images and determine whether a gallstone is causing a blockage. These tests include hepatobiliary iminodiacetic acid (HIDA) scan, magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP). Blood tests to check for any possible complications like infection, jaundice, pancreatitis or other complications caused by gallstones will also be done. Most people with gallstones that don't cause symptoms will never need treatment. However, gastroenterologists will determine whether the patient needs treatment based on his/her symptoms and the results of diagnostic testing. Treatment is usually only necessary if cholecystitis is causing symptoms, such as abdominal pain and other complications like jaundice or acute pancreatitis. In such cases, keyhole surgery to remove the gallbladder may be recommended. This procedure, known as a laparoscopic cholecystectomy, generally involves only a low risk of complications. In addition, medications to dissolve gallstones will generally be recommended for patients who cannot undergo surgery.
  5. 5. www.outsourcestrategies.com 918-221-7769 Gastroenterology medical coding involves using the specific ICD-10 and CPT codes for reporting gallstones on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to indicate a diagnosis of “Gallstones/ Cholecystitis”  K80 - Cholelithiasis  K80.0 - Calculus of gallbladder with acute cholecystitis  K80.00 - Calculus of gallbladder with acute cholecystitis, without obstruction  K80.01 - Calculus of gallbladder with acute cholecystitis, with obstruction  K80.1 - Calculus of gallbladder with other cholecystitis  K80.10 - Calculus of gallbladder with chronic cholecystitis without obstruction  K80.11 - Calculus of gallbladder with chronic cholecystitis with obstruction  K80.12 - Calculus of gallbladder with acute and chronic cholecystitis without obstruction  K80.13 - Calculus of gallbladder with acute and chronic cholecystitis with obstruction  K80.18 - Calculus of gallbladder with other cholecystitis, without obstruction  K80.19 - Calculus of gallbladder with other cholecystitis, with obstruction  K80.2 - Calculus of gallbladder without cholecystitis  K80.20 - Calculus of gallbladder without cholecystitis, without obstruction  K80.21 - Calculus of gallbladder without cholecystitis, with obstruction  K80.3 - Calculus of bile duct with cholangitis
  6. 6. www.outsourcestrategies.com 918-221-7769  K80.30 - Calculus of bile duct with cholangitis, unspecified, without obstruction  K80.31 - Calculus of bile duct with cholangitis, unspecified, with obstruction  K80.32 - Calculus of bile duct with acute cholangitis without obstruction  K80.33 - Calculus of bile duct with acute cholangitis with obstruction  K80.34 - Calculus of bile duct with chronic cholangitis without obstruction  K80.35 - Calculus of bile duct with chronic cholangitis with obstruction  K80.36 - Calculus of bile duct with acute and chronic cholangitis without obstruction  K80.37 - Calculus of bile duct with acute and chronic cholangitis with obstruction  K80.4 - Calculus of bile duct with cholecystitis  K80.40 - Calculus of bile duct with cholecystitis, unspecified, without obstruction  K80.41 - Calculus of bile duct with cholecystitis, unspecified, with obstruction  K80.42 - Calculus of bile duct with acute cholecystitis without obstruction  K80.43 - Calculus of bile duct with acute cholecystitis with obstruction  K80.44 - Calculus of bile duct with chronic cholecystitis without obstruction  K80.45 - Calculus of bile duct with chronic cholecystitis with obstruction
  7. 7. www.outsourcestrategies.com 918-221-7769  K80.46 - Calculus of bile duct with acute and chronic cholecystitis without obstruction  K80.47 - Calculus of bile duct with acute and chronic cholecystitis with obstruction  K80.5 - Calculus of bile duct without cholangitis or cholecystitis  K80.50 - Calculus of bile duct without cholangitis or cholecystitis, without obstruction  K80.51 - Calculus of bile duct without cholangitis or cholecystitis, with obstruction  K80.6 - Calculus of gallbladder and bile duct with cholecystitis  K80.60 - Calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction  K80.61 - Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction  K80.62 - Calculus of gallbladder and bile duct with acute cholecystitis without obstruction  K80.63 - Calculus of gallbladder and bile duct with acute cholecystitis with obstruction  K80.64 - Calculus of gallbladder and bile duct with chronic cholecystitis without obstruction  K80.65 - Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction  K80.66 - Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction  K80.67 - Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction  K80.7 - Calculus of gallbladder and bile duct without cholecystitis
  8. 8. www.outsourcestrategies.com 918-221-7769  K80.70 - Calculus of gallbladder and bile duct without cholecystitis, without obstruction  K80.71 - Calculus of gallbladder and bile duct without cholecystitis, with obstruction  K80.8 - Other cholelithiasis  K80.80 - Other cholelithiasis, without obstruction  K80.81 - Other cholelithiasis, with obstruction  K81 - Cholecystitis  K81.0 - Acute cholecystitis  K81.1 - Chronic cholecystitis  K81.2 - Acute cholecystitis with chronic cholecystitis  K81.9 - Cholecystitis, unspecified CPT Codes for Cholecystectomy – Removal of the Gallbladder  47562 - Laparoscopic cholecystectomy without cholangiography  47563 - Laparoscopic cholecystectomy with cholangiography  47564 - Laparoscopic cholecystectomy with exploration of the common bile duct  47600 - Cholecystectomy without cholangiography  47605 - Cholecystectomy with cholangiography  47610 - Cholecystectomy with exploration of the common bile duct Incorporating a combination of healthy lifestyle changes and medications can help control the formation of gallbladder stones. Common preventive measures include maintaining a healthy body weight, eating more fruits and vegetables, stopping the habit of skipping meals and losing body weight slowly. Treating physicians need to maintain accurate medical documentation of cholecystitis. Partnering with a reliable and experienced medical billing company can ensure accurate reporting of gastroenterology diagnosis and
  9. 9. www.outsourcestrategies.com 918-221-7769 procedures. Reputable companies will have experienced AAPC-certified coders on board who have adequate knowledge about billing and coding guidelines related to this medical specialty and can ensure accurate claims for optimal reimbursement.

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