AHA Coding Clinic® for ICD-9 - 2011 Issue 3; Ask the Editor

Nonessential Modifiers

Please clarify whether nonessential modifiers in the Index to Diseases apply to subterms following a main term. Coders at our facility have different opinions on coding a diagnosis of "GI bleeding due to ischemic colitis." For example, the main term "colitis" has several nonessential modifiers, including "(hemorrhagic)." Does this nonessential modifier apply to the subterm under colitis, "ischemic"? One could assume that the nonessential modifier applies only to colitis and the default code 558.9. This issue has not been addressed in the Official Guidelines for Coding and Reporting. According to Coding Clinic Second Quarter 2008, pages 15-16, "GI bleeding due to acute ischemic colitis is assigned code 557.0, Acute vascular insufficiency of intestine." The previously published advice precluded the coding of hemorrhage because of the inclusion term in the Tabular List, but we are wondering about other subentries under colitis where there is not an inclusion term in the Tabular List. ...

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