Anatomy and

Pathophysiology
for ICD-10
Module 6
 Disclaimer
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ICD-10 Experts
Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC, COBGC
VP, ICD-10 Training and Education
Shelly Cronin, CPC, CPMA, CPC-I, CANPC, CGSC, CGIC, CPPM
Director, ICD-10 Training
Betty Hovey, CPC, CPMA, CPC-I, CPC-H, CPB, CPCD
Director, ICD-10 Development and Training
Jackie Stack, CPC, CPB, CPC-I, CEMC, CFPC, CIMC, CPEDC
Director, ICD-10 Development and Training
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Director, ICD-10 Development and Training

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ii Anatomy and Pathophysiology for ICD-10 © 2013 AAPC. All rights reserved.
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 Content
Module 6
Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
General Structure and Function of the Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Specialized Epithelial Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Diseases, Disorders, Injuries, and Other Conditions of the Digestive System . . . . . . . . . . . . . . . . . . . 5

© 2013 AAPC. All rights reserved. www.aapc.com iii

111213
 Module
6 Digestive System
Terminology
Anastomosis—A surgical connection between two
hollow, tubular structures.
Alimentary—Concerning food, nourishment, and the
organs of digestion.
Bile—A bitter, yellow-green secretion of the liver.
Cecum—First portion of the large intestine situated in
the lower right quadrant of the abdomen.
Colon—Part of the large intestine running from the
cecum to the rectum assisting in food digestion and
waste removal in the body.
Colostomy—A surgical procedure in which one end of
the large intestine is brought out through the abdominal
wall where stool is collected in a bag attached to the
abdomen.
Duodenum—The first part of the small intestine
extending from the pylorus (at the bottom of the
stomach) to the jejunum.
Dyskinesia—Difficulty or distortion in performing
voluntary movements.
Dysplasia—Abnormal growth or development of cells
or organs.
Enterostomy—A surgical procedure in which one end
of the small intestine is brought out through the abdom-
inal wall where stool is collected in a bag attached to the
abdomen.
Esophagostomy—Surgical creation of an artificial
opening into the esophagus to allow for nutritional
support.
Gastrostomy—Surgical creation of an artificial opening
into the stomach to allow for nutritional support.
Hemorrhage—Bleeding or abnormal flow of blood.
© 2013 AAPC. All rights reserved. www.aapc.com 1
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Ileum—Lowest part of small intestine continuing from
the jejunum, located just before the large intestine.
Jejunum—Part of the small intestine located between
the duodenum and ileum.
Malabsorption—Impaired absorption of nutrient of
food by the intestines.
Mastication—Chewing, tearing, or grinding food with
teeth as it is mixed with saliva.
Perforation—A hole that develops through the entire wall
of the stomach, small or large intestine, or gallbladder.
Pyloric sphincter—A muscular ring in the stomach
that controls passage of food from the stomach into the
duodenum.
Introduction
The digestive system is made up of the gastrointestinal
tract (GI tract), also known as the alimentary canal.
The mouth, pharynx, esophagus, stomach, small intes-
tine, large intestine, rectum, and anus all make up the
digestive tract, which is basically a food-processing pipe
about 30 ft. long. Associated digestive structures include
three pairs of salivary glands, the pancreas, the liver,
and the gallbladder, each with a very important role.
The appendix—a short, blind-ended tube attached to the
large intestine—has no known function. Food is moved
through the digestive tract by muscular contractions
called peristalsis until it is eliminated from the body.
The primary function of the digestive system is to break
down the food we eat into smaller parts so the body can
use it to build and nourish cells and provide energy. This
process is carried out by:
• Ingesting food
• The body propels the food through the GI tract
from mouth to anus
Digestive System Module 6

• Mucus, water, enzymes, and other digestive

substances are secreted to break the food down
• Food particles are mechanically and chemically
digested into absorbable nutrients
• Digested particles are absorbed
• Waste products are eliminated from the body
through defecation

Food enters the digestive system through the mouth

and is cut, crushed, and ground by teeth. The muscular
tongue moves the food around in the mouth. As food is
swallowed it moves down the pharynx (throat), where
salivary glands secrete saliva, which contains enzymes
to start digestion. It continues to be propelled through
the esophagus and into the stomach. The stomach is
a J-shaped muscular bag that adds gastric acids while
it churns, digests, and stores food. The food becomes
liquefied to enter the small intestine where additional
Source: AAPC
chemical secretions from the pancreas, liver, and gall-
bladder are added to digest the food into absorbable
nutrients. The walls of the small intestines absorb the The mucosa is the innermost layer of tissue lining the
nutrients while unused waste products move into the GI tract. It contains three sublayers: mucous epithelium,
colon, or large intestine where fluid is removed. Waste lamina propria, and muscularis mucosae. Certain cells
then becomes solid and is defecated through the anus. in the mucosa secrete mucus, digestive enzymes, and
hormones. Ducts from other glands pass through the
mucosa to the lumen. In the mouth and anus, where
General Structure and thickness for protection against abrasion is needed, the
Function of the Digestive System epithelium is stratified squamous tissue. The stomach
and intestines have a thin simple columnar epithelial
Remarkably diverse and specialized processes take place
layer for secretion and absorption.
in different sections of the digestive tract, but there is
a fundamental consistency in the architecture of the The submucosa is a thick layer of loose connective tissue
tubular digestive tract. From the mouth to the anus, that surrounds the mucosa. This layer also contains
the wall of the digestive tube is composed of four basic blood vessels, lymphatic vessels, and nerves. Glands may
layers or tunics. The layers vary in thickness and tissue/ be embedded in this layer.
cell type (connective, muscle, and epithelial). They have
sublayers and contain other functional structures, such Above the diaphragm, the outermost layer of the GI
as glands, blood and lymph vessels, and nerve fibers. tract is a connective tissue called adventitia. Below the
Beginning with the innermost layer, the four layers of diaphragm, it is called serosa.
the digestive tube are the:

• Mucosa Specialized Epithelial Cells

• Submucosa The digestive system contains a number of highly
specialized cell types, each of which has very specific
• Muscularis
functions. Epithelial cells line the inner surface of the
• Serosa stomach, and secrete about 2 liters of gastric juices per
day. Gastric juice contains hydrochloric acid, pepsin-
ogen, and mucus, which are important digestive ingre-
dients. Secretions are controlled by nervous (smells,

2 Anatomy and Pathophysiology for ICD-10 © 2013 AAPC. All rights reserved.
111213
Module 6 Digestive System

thoughts, and caffeine) and endocrine signals. Most of easily digested, while saliva mixes with food to begin
the cells carrying out the functions
Digestive Tract of the GI system are the process of breaking it down into a form your body
specialized epithelial cells. can absorb and use. The tongue, salivary glands, and
the teeth are critical to the digestion process in the oral
cavity. Taste buds are clusters of cells on the tongue that
respond to food by initiating secretion of saliva (up to
Oral cavity Pharynx one liter each day) and gastric acid.
Esophagus The esophagus, which is located in your throat near the
trachea, receives food from your mouth when it is swal-
Stomach lowed. Each end the esophagus is opened and closed by
Liver a sphincter. The upper esophageal sphincter prevents
Gallbladder Duodenum
air from entering the esophagus during respiration.
Ascending Transverse Normally, the lower esophageal sphincter closes after
colon colon
food enters the stomach; however, if it fails to close or
Ileum Descending
Site of colon remains closed, gastric juices may flow back into the
ileocecal esophagus, causing gastroesophageal reflux. Rhythmic
valve
Jejunum contractions occur, called peristalsis, to propel liquids
and solids through the esophagus to the stomach.
Cecum Sigmoid
colon The stomach is a hollow organ, or “container,” that holds
Rectum
Appendix food while it is being mixed with enzymes that continue
Anal canal the process of breaking down food into a usable form,
called chyme. It has three major parts: the fundus,
which is the upper rounded portion of the stomach, the
body, which is the central part of the stomach, and the
pylorus, which is the lower tubular part of the stomach.
Cells in the lining of the stomach secrete strong acid
and powerful enzymes that are responsible for the
breakdown process. When the contents of the stomach
are sufficiently processed, they are released into the
small intestine. Gastric juices are composed of digestive
enzymes and hydrochloric acid. A thick mucus layer
Copyright OptumInsight. All rights reserved coats the mucosa and helps keep the acidic digestive
juice from dissolving the tissue of the stomach itself.
Organ Function in The small intestine is made up of three segments—the
the Digestive System duodenum, jejunum, and ileum—the small intestine is a
The digestive system has the unique function of turning 22-foot long muscular tube that breaks down food using
food into energy needed for survival and removing enzymes released by the pancreas and bile from the liver.
unused products for waste disposal. They work together Peristalsis also is at work in this organ, moving food
in a very complex way and consist of the mouth (oral through and mixing it with digestive secretions from the
cavity), the esophagus, the stomach, the small and large pancreas and liver. The duodenum is largely responsible
intestines, and the accessory organs of digestion: the for the continuous breaking-down process, with the
liver, gallbladder, and exocrine pancreas. jejunum and ileum mainly responsible for absorption of
nutrients into the bloodstream.
The mouth is the beginning of the digestive tract; and,
in fact, digestion starts here when taking the first bite of Contents of the small intestine start out semi-solid, and
food. Chewing breaks the food into pieces that are more end in a liquid form after passing through the organ.

© 2013 AAPC. All rights reserved. www.aapc.com 3

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Digestive System Module 6
Water, bile, enzymes, and mucous contribute to the
change in consistency. Once the nutrients have been
absorbed and the leftover-food residue liquid has passed
through the small intestine, it then moves on to the large
intestine, or colon.
The pancreas secretes digestive enzymes into the
duodenum, the first segment of the small intestine.
These enzymes break down protein, fats, and carbo-
hydrates. The pancreas also makes insulin, secreting
it directly into the bloodstream. Insulin is the chief
hormone for metabolizing sugar.
The liver has multiple functions, but its main function
within the digestive system is to process the nutrients
absorbed from the small intestine. Bile from the liver is
stored in the gallbladder in between meals. At mealtime,
it is squeezed out of the gallbladder, through the bile
ducts, and into the intestine to mix with the fat in food.
The bile acids dissolve fat into the watery contents of
the intestine, which are digested by enzymes from the
pancreas, and the lining of the intestine. In addition, the
liver is the body’s chemical “factory.” It takes the raw
materials absorbed by the intestine and makes all the
various chemicals the body needs to function. The liver
also detoxifies potentially harmful chemicals. It breaks
down and secretes many drugs.
The colon (or large intestine) is a 6-foot long muscular
tube that connects the small intestine to the rectum. The
large intestine is made up of the cecum, the ascending
(right) colon, the transverse (across) colon, the
descending (left) colon, and the sigmoid colon, which
connects to the rectum. The appendix is a small tube
attached to the cecum. The large intestine is a highly
specialized organ that is responsible for processing waste
so that emptying the bowels is easy and convenient.
4 Anatomy and Pathophysiology for ICD-10 © 2013 AAPC. All rights reserved.
Transverse colon Splenic
Hepatic
Descending
Ascending colon 10 %
colon Sigmoid
15% 5%
Appendix
Rectum Sigmoid 50%
colon 20 %
Anatomical distribution
of large bowel cancers
Copyright OptumInsight. All rights reserved
Stool, or waste left over from the digestive process, is
passed through the colon by means of peristalsis, first
in a liquid state and ultimately in a solid form. As stool
passes through the colon, water is removed. Stool is
stored in the sigmoid (S-shaped) colon until a “mass
movement” empties it into the rectum once or twice
a day. It normally takes about 36 hours for stool to get
through the colon. The stool itself is mostly food debris
and bacteria. These bacteria perform several useful func-
tions, such as synthesizing various vitamins, processing
waste products and food particles, and protecting
against harmful bacteria. When the descending colon
becomes full of stool, or feces, it empties its contents into
the rectum to begin the process of elimination.
The rectum is an 8-inch chamber that connects the
colon to the anus. It is the rectum’s job to receive stool
from the colon, to let the person know that there is stool
to be evacuated, and to hold the stool until evacuation
happens. When anything (gas or stool) comes into the
rectum, sensors send a message to the brain. The brain
then decides if the rectal contents can be released or not.
If they can, the sphincters relax and the rectum contracts,
disposing its contents. If the contents cannot be disposed,
the sphincter contracts and the rectum accommodates so
that the sensation temporarily goes away.
The anus is the final part of the digestive tract. It is
a two-inch long canal consisting of the pelvic floor
muscles and the two anal sphincters (internal and
external). The lining of the upper anus is specialized
to detect rectal contents. It lets you know whether the
contents are liquid, gas, or solid. Sphincter muscles that
111213
Module 6 Digestive System

are important in allowing control of stool surround the
anus. The pelvic floor muscle creates an angle between
the rectum and the anus that stops stool from coming
out when it is not supposed to. The internal sphincter
is always tight, except when stool enters the rectum.
It keeps us continent when we are asleep or otherwise
unaware of the presence of stool. When we get an urge
to go to the bathroom, we rely on our external sphincter
to hold the stool until reaching a toilet, where it then
relaxes to release the contents.
Diseases, Disorders,
Injuries, and Other
Conditions of the Digestive System
Esophageal Disorders
A very common disorder that can affect the esophagus
is Gastroesophageal Reflux Disease (GERD), which is
caused by weakness of the lower esophageal sphincter.
Stomach acid is normally removed from the esophagus
through the process of peristalsis, squeezing movements
to push acid into the stomach. The sphincter may not
close tightly enough or may relax too much during the
course of the day or at night causing the backflow of acid
and bile found in the stomach to aide in the digestion
process. Barrett’s esophagus is a condition in which the
lining of the esophagus is damaged, most commonly
found in patients with GERD due to chronic inflamma-
tion of the esophagus. A diagnosis of Barrett’s esoph-
agus may be concerning because it increases the risk of a
patient developing esophageal cancer.
Diverticulum of esophagus, acquired K22.5
gastro-esophageal laceration-hemorrhage K22.6
syndrome
Barrett’s esophagus without dyspla-sia K22.70
Barrett’s esophagus with low grade K22.710
dysplasia
Barrett’s esophagus with high grade K22.711
dysplasia
Barrett’s esophagus with dysplasia, K22.719
unspecified
Other specified diseases of the eso-phagus K22.8
Diseases of esophagus, unspecified K22.9
Disorders of esophagus in diseases classi- K23
fied elsewhere
Stomach and Duodenal Ulcers
Ulcers are open sores or lesions. They are found in the
skin or mucous membranes of areas of the body. A
stomach ulcer is called a gastric ulcer and an ulcer in the
duodenum is called a duodenal ulcer. Lifestyle, stress and
diet used to be thought to cause ulcers. These factors may
have a role in ulcer formation; however, they are not the
main cause of them. Scientists now know that ulcers are
caused by hydrochloric acid and pepsin that are contained
in our stomach and duodenal parts of our digestive
system and that these acids contribute to ulcer formation.
The ICD-10-CM code range for stomach and duodenal
ulcers is K25.0–K28.9.

The ICD-10-CM code range for disorders of the esoph-

agus is K20.0–K23

Eosinophilic esophagitis K20.0

Other esophagitis K20.8
Esophagitis, unspecified K20.9
Achalasia of cardia K22.0
Ulcer of esophagus without bleeding K22.10
Ulcer of esophagus with bleeding K22.11
Esophageal obstruction K22.2
Perforation of esophagus K22.3
Dyskinesia of esophagus K22.4

© 2013 AAPC. All rights reserved. www.aapc.com 5

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Digestive System Module 6

Chronic or unspecified gastric ulcer with

K25.5
perforation

Chronic or unspecified gastric ulcer with

K25.6
both hemorrhage and perforation

Chronic or unspecified gastric ulcer

K25.7
without hemorrhage or perforation

Gastric ulcer, unspecified as acute

or chronic, without hemorrhage or K25.9
perforation

Currently there are no ICD-10-CM guidelines

specifically related to this condition.

Source: AAPC

The following information is required to code for these Knotted

intestine
types of ulcers: (volvulus)

• Acute or chronic condition

• Hemorrhage
• Perforation
• Hemorrhage with perforation
Diverticulum
• Without hemorrhage or perforation

Acute gastric ulcer with hemorrhage K25.0 Copyright OptumInsight. All rights reserved

Acute gastric ulcer with perforation K25.1 Diverticulitis and Diverticulosis

Pressure within the colon causes bulging pockets of
Acute gastric ulcer with both hemorrhage
K25.2 tissue (sacs) that push out from the colonic walls as a
and perforation
person ages. A small bulging sac pushing outward from
the colon wall is called a diverticulum. More than one
Acute gastric ulcer without hemorrhage
K25.3 bulging sac is referred to in the plural as diverticula.
or perforation
Diverticula can occur throughout the colon but are
most common near the end of the left colon referred
to as the sigmoid colon. The condition of having these
Chronic or unspecified gastric ulcer with
K25.4 diverticula in the colon is called diverticulosis, which
hemorrhage
is a very common condition. It is found in more than
half of Americans over age 60. Only a small percentage
of these people will develop the complication of

6 Anatomy and Pathophysiology for ICD-10 © 2013 AAPC. All rights reserved.
111213
Module 6 Digestive System
diverticulitis. Inflammation or a small tear in a diver-
ticulum causes diverticulitis. If the tear is large, stool in
the colon can spill into the abdominal cavity, causing
an infection or abscess in the abdomen. Symptoms
include abdominal pain, chills, fever, nausea, vomiting,
or weight loss. Eating foods high in fiber can reduce the
risk for this condition.
The ICD-10-CM code range for Diverticulitis and Diver-
ticulosis is K57.00–K57.93.
The following information is required to code for this
these conditions:
• Site of inflammation or disease
• Perforation or abscess
• If bleeding is present
Diverticulitis of small intestine with perfo-
K57.0
ration and abscess
Diverticulitis of small intestine with perfo-
K57.00
ration and abscess without bleeding
Diverticulitis of small intestine with perfo-
K57.01
ration and abscess with bleeding
Diverticular disease of small intestine
K57.1
without perforation or abscess
Diverticulosis of small intestine without
K57.10
perforation or abscess without bleeding
Diverticulosis of small intestine without
K57.11
perforation or abscess with bleeding
Diverticulitis of small intestine without
K57.12
perforation or abscess without bleeding
Diverticulitis of small intestine without
K57.13
perforation or abscess with bleeding
Diverticular disease of large intestine
K57.3
without perforation or abscess
© 2013 AAPC. All rights reserved. www.aapc.com 7
111213
Diverticulosis of large intestine without
K57.30
perforation or abscess without bleeding
Diverticulosis of large intestine without
K57.31
perforation or abscess with bleeding
Diverticulitis of large intestine without
K57.32
perforation or abscess without bleeding
Diverticulitis of large intestine without
K57.33
perforation or abscess without bleeding
In the table, the information that is necessary in the
documentation is shown. Indication of where the disease
or inflammation is located as well as if perforation or
abscess, and if bleeding is present is vital in coding
diverticulitis or diverticulosis.
Direct
inguinal Incarcerated
hernia hernia
(between
deep inferior
epigastric
vessels and
rectus fascia)
Copyright OptumInsight. All rights reserved
Hernias
A hernia is the protrusion of an organ or the fascia of
an organ through the wall of the cavity that normally
contains it. A hiatal hernia occurs when the stomach
protrudes into the mediastinum through the esophageal
opening in the diaphragm.
By far the most common hernias develop in the
abdomen, when a weakness in the abdominal wall
evolves into a localized hole, or “defect”, through which
fatty tissue, or abdominal organs covered with perito-
neum, may protrude. Hernias may or may not present
either with pain at the site, a visible or palpable lump, or
in some cases by more vague symptoms resulting from
Digestive System Module 6

pressure on an organ which has become “stuck” in the

hernia, sometimes leading to organ dysfunction. Fatty
tissue usually enters a hernia first, but it may be followed
by or accompanied by an organ. Most of the time,
hernias develop when pressure in the compartment of
the residing organ is increased, and the boundary is
weak or weakened.
Many conditions chronically increase intra-abdominal
pressure, (pregnancy, ascites, COPD, dyschezia, benign
prostatic hypertrophy) and explain why abdominal
hernias are very common.
The ICD-10-CM code range for hernias is K40.00–K46.9.
The following information is required to code for these
conditions:
• Site of hernia
• Laterality, when appropriate
• If gangrene or obstruction is present
• If condition is recurrent
Bilateral inguinal hernia, with obstruction,
K40.00
without gangrene, not specified as recurrent
Bilateral inguinal hernia, with obstruction,
K40.01
without gangrene, recurrent
Unilateral inguinal hernia, with gangrene,
K40.41
recurrent
Bilateral inguinal hernia, without
obstruction or gangrene, not specified as K40.20
recurrent
Bilateral inguinal hernia, without
K40.21
obstruction or gangrene, recurrent
Unilateral inguinal hernia, without
obstruction or gangrene, not specified as K40.90
recurrent
Unilateral inguinal hernia, without
K40.91
obstruction or gangrene, recurrent
In the table above, the laterality is shown (as appropriate
depending on the hernia). The fourth digits indicate the
presence of an obstruction or gangrene, while the fifth
digits indicate if the condition is specified as recurrent
or not.
The guidelines that precede this section in the tabular
area indicate that a hernia with both gangrene and
obstruction is classified to hernia with gangrene.

Unilateral inguinal hernia, with obstruction,

K40.30 Right and left
without gangrene, not specified as recurrent Right hepatic artery
bile ducts

Unilateral inguinal hernia, with Cystic artery

K40.31 Triangle of
obstruction, without gangrene, recurrent Calot
Common
hepatic
artery
Bilateral inguinal hernia with gangrene, Portal
K40.10 Cystic
vein
not specified as recurrent
duct
Gallstone
Common
Bilateral inguinal hernia with gangrene, in fundus
Hartmann’s bile duct
K40.11 empties
recurrent pouch
(infundibulum) into
Duodenum
Unilateral inguinal hernia, with gangrene,
K40.40
not specified as recurrent
Copyright OptumInsight. All rights reserved

8 Anatomy and Pathophysiology for ICD-10 © 2013 AAPC. All rights reserved.
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Module 6 Digestive System

Cholelithiasis Calculus of gallbladder with chronic

Cholelithiasis is the presence of one or more calculi K80.11
cholecystitis with obstruction
(gallstone) in the gallbladder. Gallstones are hard,
pebble-like deposits that form inside the gallbladder. Calculus of gallbladder with acute and
They may be as small as a grain of sand or as large as a K80.12
chronic cholecystitis without obstruction
golf ball. Failure of the gallbladder to empty bile prop-
erly (likely to happen during pregnancy), and medical Calculus of gallbladder with acute and
conditions that causes the liver to make too much bili- K80.13
chronic cholecystitis with obstruction
rubin can commonly cause one to develop gallstones.
The most common types of gallstones are the ones made Calculus of gallbladder with other
out of cholesterol, which has nothing to do with the K80.18
cholecystitis without obstruction
cholesterol levels in the blood.

Choledocholithiasis occurs if a large stone blocks Calculus of gallbladder with other

K80.19
either the cystic duct or the common bile duct causing cholecystitis with obstruction
cramping pain in the middle to right upper abdomen.
The pain is relieved if the stone passes into the first part Calculus of the bile duct with cholangitis,
of the small intestine (the duodenum). Other possible K80.30
unspecified, without obstruction
symptoms may include fever, yellowing of skin and
whites of eyes (jaundice), abdominal fullness, clay- Calculus of the bile duct with cholangitis,
colored stools, and nausea and vomiting. K80.31
unspecified, with obstruction
Cholangitis is an infection of the common bile duct, the
tube that carries bile from the liver to the gallbladder Calculus of the bile duct with acute
K80.32
and intestines. It is usually caused by a bacterial infec- cholangitis, without obstruction
tion, which can occur when from blockage of the duct,
such as a gallstone or tumor. Calculus of the bile duct with acute
K80.33
cholangitis with obstruction
The ICD-10-CM code range for disorders of gallbladder,
biliary tract and pancreas is K80.00–K87. Calculus of the bile duct with chronic
K80.34
cholangitis without obstruction
The following information is required to code for these
conditions: Calculus of the bile duct with chronic
K80.35
• Site cholangitis with obstruction
• Acute or chronic
Calculus of the bile duct with acute and
• With or without obstruction K80.36
chronic cholangitis without obstruction

Calculus of the bile duct with acute and

Calculus of gallbladder with acute K80.37
K80.00 chronic cholangitis with obstruction
cholecystitis without obstruction

Calculus of gallbladder with acute The table above demonstrates the importance of
K80.01
cholecystitis with obstruction specifying if the condition is acute or chronic, and
where the stones are located, as well as if there is an
obstruction present.
Calculus of gallbladder with chronic
K80.10
cholecystitis without obstruction

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Digestive System Module 6

Intraoperative and Vomiting following gastrointestinal surgery K91.0

postprocedural complications Postgastric surgery syndromes K91.1
Complications of procedures performed on the diges- Postsurgical malabsorption, not elsewhere K91.2
tive system codes are found in the digestive chapter. The classified
codes in ICD-10-CM for complications of surgery on
Postprocedural intestinal obstruction K91.3
the digestive system are found in categories K91–K94.39.
They are classified as “intraoperative” and “postpro- Postcholecystectomy syndrome K91.5
cedural”, and additional information will need to be Intraoperative hemorrhage and hematoma K91.61
obtained if it is not documented in the note. Some of of a digestive system organ or structure
these complications include obstruction, hemorrhage, complicating a digestive system procedure
hematoma, and infection. In patients who have had Intraoperative hemorrhage and hematoma K91.62
gastric bypass surgery some of the complications may of a digestive system organ or structure
also include vomiting, dumping syndrome, and post- complicating other procedure
surgical malabsorption. Dumping syndrome occurs
Accidental puncture and laceration of a K91.71
when the patient eats foods rich in sugar content and
digestive system organ or structure during a
the body floods the intestines in an attempt to dilute
digestive system procedure
the sugar. The patient may experience a rapid and
forceful heart rate and anxiety as well as nausea, which Accidental puncture and laceration of a K91.72
may also be followed by diarrhea. Due to the fact that digestive system organ or structure during a
gastric bypass surgery reduces the amount of food that digestive system procedure
the stomach can store, it is very important for these Other intraoperative complications of K91.81
patients to ensure that the food they ingest provides a digestive system
good balance of nutrition. Not only does their intake Postprocedural hepatic failure K91.82
amount decline, but also the rate at which their bodies Postprocedureal hepatorenal syndrome K91.83
absorb the food. The number of acid producing cells in
the lining of the stomach increase after bypass surgery Postprocedural hemorrhage and hematoma K91.840
so the physician may recommend use of acid reducing of a digestive system organ or structure
medications, which may then cause a condition known following a digestive system procedure
as achlorhydria (not enough acid in the stomach). With Postprocedural hemorrhage and hematoma K91.841
such low levels of acidity in the stomach, patients are at of a digestive system organ or structure
risk of developing overgrowth of bacteria in the stomach following other procedure
causing nausea and vomiting. Extended symptoms of Pouchitis K91.850
nausea and vomiting will lead to malnutrition so the Other complications of intestinal pouch K91.858
physician must closely monitor the level of acidity in the
Other postprocedural complications and K91.89
stomach and the patient must work closely with a dieti-
disorders of digestive system
tian to ensure a well-balanced intake of foods.

The ICD-10-CM code range for Intraoperative and Additionally, there are specific ICD-10-CM codes for
postprocedural complications is K91.0–K94.39. reporting complications of artificial openings of the
digestive system. These codes require the following
The following information is required to code for these information:
conditions:
• Type of surgery that caused the artificial opening
• Intraoperative or postprocedural complication
• Type of complication
• Type of complication
• Type of procedure performed Colostomy complication, unspecified K94.00
Colostomy hemorrhage K94.01

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Module 6 Digestive System

Colostomy infection K94.02

Colostomy malfunction K94.03
Other complications of colostomy K94.09
Enterostomy complication, unspecified K94.10
Enterostomy hemorrhage K94.11
Enterostomy infection K94.12
Enterostomy malfunction K94.13
Other complications of enterostomy K94.19
Gastrostomy complication, unspecified K94.20
Gastrostomy hemorrhage K94.21
Gastrostomy infection K94.22
Gastrostomy malfunction K94.23
Other complications of gastrostomy K94.29
Esophagostomy complication, unspecified K94.30
Esophagostomy hemorrhage K94.31
Esophagostomy infection K94.32
Esophagostomy malfunction K94.33
Other complications of esophagostomy K94.39

When coding for an infection, ICD-10-CM instructs the

user to:

Use additional code to specify type of infection, such as:

Cellulitis of abdominal wall (L03.32)

Sepsis (A40.-, A41.-)

Sources
Comprehensive Medical Terminology (Fourth Edition) by
Betty Davis Jones.

Stedman’s Medical Dictionary, 28th edition

Bates’ Pocket Guide to Physical Examination and History

Taking, Third Edition (Lynn S. Bickley-Lippincott)

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