Q&A: Obtaining clarification for Schatzki’s Ring

January 3, 2013

Q: A few times I have seen physicians document Schatzki’s Ring. I understand that if the physician documents “acquired Schatzki’s Ring” that maps to code 530.3 no CC/MCC. However, how would it be coded if the physician does not document “acquired” and only documents “Schatzki’s Ring”? Could it be considered an MCC or would we need to query the physician?

I am also wondering what clinical criteria needs to be present, does the patient need to have a related esophageal principal diagnosis or would this diagnosis fall into a congenital defect?

SB: If the physician does not specify the condition as “acquired” it defaults to 750.3. To assign a code for this condition it would have to meet one of the following five criteria for reporting a secondary diagnoses:

clinical evaluation; or
therapeutic treatment; or
diagnostic procedures; or
extended length of hospital stay; or
increased nursing care and/or monitoring

JK: AHA’s Coding Clinic for ICD-9-CM, 1^st Quarter, 2012, pp. 15-16, discussed this very issue. In it, guidance calls for querying the physician for clarification when documentation indicates “newly diagnosed Schatzki Ring in an adult patient without additional information regarding whether the condition is congenital or acquired.”

Coding Clinic states that code 530.3 should be used if the condition is acquired. When the physician is unable to determine the type, then the ICD-9-CM code defaults to congenital.

“However, Schatzki’s Ring would be a reportable condition only if it meets the definition of a secondary diagnosis, in that it must be clinically significant or symptomatic. In most cases, when a Schatzki’s Ring is found, it is an incidental finding,” Coding Clinic states.

Based on this Coding Clinic it appears to me that Schatzki’s Ring documented as an incidental finding should not be coded. If it is “clinically significant” or symptomatic, then a query is required to determine if the condition was acquired or congenital. If so, code 530.3 can be assigned.

Editor’s Note:This question was answered by ACDIS Advisory Board members Susan Belley, M.Ed., RHIA, CPHQ, Project Manager for 3M HIS Consulting Services in Atlanta and James S. Kennedy, MD, CCS, Managing Director at FTI Healthcare in Brentwood, Tenn. It was originally published on the ACDIS Blog.

Found in Categories:

Ask ACDIS