Alicia: Oh, GERD.
Laureen: I always want to growl when I say that, GERD.
Alicia: GERD is fun also.
The reasonÖ I actually came up with this because I experienced it with a chart that
I was working on here recently.
And it threw me for a minute and I thought, ìOh, Iíve never had a problem with that
where I had the same.î GERD is 530.81.
You just always assume that.
But the doctor had actually pre-populated the diagnosis.
He wrote GERD ñ 530.11.
So I went and looked it up and I thought, ìOh wow.î You know, 530.81 is esophageal
reflex which is GERD ñ Gastro Esophageal Reflex Disease. 530.11 is reflex esophagitis.
And so then I thought, ìWell, letís go look them both up as if you havenít looked, as
if you didnít know what they were.î
So if we go into the answerÖ and when I saw this, I thought, ìYou know, I canít be the
only one that stumbled on this.
This has got to be one of those basic questions that when people are learning to code, where
the terminology really plays a major role in what youíre looking for.î
Okay so these codes, they get confusing so what you need to be aware of and especially,
like I said, if your doctor pre-populates your encounter or theyíre using those encounter
forms and they you know, diagnose GERD which is Gastroesophageal Reflex DiseaseÖ you know,
how do you look up this diagnosis in the index?
So the first thing you would do is when youíre looking at this diagnosis, youíre going to
look up reflex because thatís what the person has.
They have reflex.
Where do they have the reflex?
Itís in the esophagus.
Okay so thatís your 530.81.
Thatís where the index is going to take you.
You go to the tabular and youíll find that.
Now when you look at the tabular though, when you look under 530.8, the title is going to
say ëother specified disorders of the esophagusí.
Okay so youíre thinking, ìWell okay, thatís not going to say GERD by the way.î Thatís
an abbreviation.
So then you see 530.81 equals esophageal reflex or gastroesophageal reflex.
Okay, like I said, itís not going to say GERD.
You just have to know thatís what it stands for.
So gastroesophagitis is actually different.
It also has reflex but itís an inflammation.
The key there is the suffix of ñitis.
And if you remember your terminology, -itis means inflammation.
Okay so to be able to use the .11, you have to have inflammation documented.
Okay so if he says esophagitis or he gives other indication that there is an inflammation,
you can use the 530.11.
And actually, what triggered it for me was when I used the Find A Code and I typed in
the 530.11 and the additional note popped up and stated that you know, inflammation
has to be documented.
Okay so hereís an example.
This is almost exactly like whatÖ I remember the report to show.
So your patient hasÖ oh well, I canít remember off the top of my head.
Okay, there we go.
Okay, patient was seen today with what she stated was heartburn.
Tums is given, no relief.
She states that tomatoes seem to increase her discomfort.
Now sheís getting a pressure, a feeling in her chest.
Previous cardio work up revealed no concern and something else.
No family history of cardiac trouble.
Impression ñ so this is where he puts his diagnosis.
Sometimes it wonít say diagnosis.
This is his impression and he says GERD ñ 530.11.
Okay so some coders will just say, ìOkay, he said 530.11.
Thatís my code.î He goe on to say you know, the plan is what?
You know, the treatment theyíre going to get.
So theyíre going to start the patient onÖ I canít say the word.
Itís like (45.50) but itís not.
One every day times 30 days and instructed to follow up in one month, sooner if symptoms
do not improve.
Okay, nowhere in that documentation does he nidicate that thereís inflammation.
So you canít use the 530.11.
Thatís not the right code.
The right codeís 530.81.
Thatís the proper code for GERD.
Just because the doctor wrote a code down, you canít use that.
Heís not a coder, heís a doctor.
So go ahead and scroll down just a little bit.
I t hink I have another example.
Okay, result for Mr. Greenís EGD revealed inflammation of esophageal lining due to reflex
with no ulcer or polyps noted, 530.11.
That guyís got esophagealÖ gastroesophagealitis.
You know, heís inflamed.
So 530.11 is the proper code.
So know your terminology.
Know your prefixes and suffixes because they really do play a part in what is the proper
code to use.
And these are the type of things that will get you on the exam.
Theyíll give you a choice of 530.11 for GERD and that is not the proper code unless inflammation
is used or indicated in the documentation.
Laureen: Great.
Thanks Alicia.
Alicia: Youíre welcome.
Laureen: GERD.. and you donít want to show anything on Find A Code, right?
Alicia: Well you know what?
Yeah, I did.
If youÖ okay, seeÖ letís see.
I think itís in the additional information.
Click that.
Where is it?
It was something that may pop up and stated specifically that it had to be inflammation.
Laureen: Right here?
Alicia: This inflammation isÖ nah.
Laureen: Was this the code?
Alicia: Oh you know what?
Go to GERD - 530.85.
I think it must have been in that one.
Then it refers you back to good old plain 11.
Thatís what it was.
Sorry, oh waitÖ GERD is 81.
Iím sorry.
Laureen: Donít do as we do.
Do as we say.
Alicia: Yes, thatís right.
See right there where it tells you?
See how great Find A Code was?
As soon as I popped that in because I thought, ìWell no, isnít GERD 530.81?î and looked
down there, it says, ìNote that code 530.11 should be used if this results in inflammation
of the esophagus.î So if I had not seen that, I would have maybe assumed that it was okay.
And that was a big heads up.
That is not in your coding manuals, ladies and gentlemen.
That is on Find A Code.
That is notÖ youíre going to have to write that in your manuals.
Laureen: Yeah, this plain English description has helped me quite often too, Iíd have to
say.
And weíll be giving you some more info on Find A code and how to get a discount on that.
Alright great, thank you.