Colon Polyps – Diagnosis and ICD-10 Coding | Medical Coding (2024)

A colon polyp is a growth that forms on the lining of the colon (large intestine) or rectum. Colon polyps are usually harmless, but can develop into colon cancer. There are many types of polyps and the five most common types are: inflammatory, hyperplastic, adenomatous, villous and serrated. For gastroenterology medical coding service providers to assign the correct ICD-10 code for colon polyps, the documentation should clearly specify the location and the type of polyp (benign, inflammatory, serrated, hyperplastic, etc) as confirmed by colonoscopy.

Incidence

Colon polyps are common in American adults, especially among men and older adults. The U.S. Department of Health and Human Service estimates that about 15 to 40 percent of adults may have colon polyps. Colon polyps are more common in men and older adults. While colon (colorectal) cancer is the third most common cancer in the United States, it is one of the most preventable and curable. Colorectal cancer screening and removal of polyps in the early stages can reduce risk of colorectal cancer.

Risk Factors, Symptoms and Diagnosis

Colon polyps can develop in anyone, though people who are 50 or older are at a higher risk. Other risk factors include being overweight or a smoker, or having a personal or family history of colon polyps or colon cancer.

Colon polyps have various shapes and be flat, slightly raised (sessile) or on a stalk (pedunculated). They can be hyperplastic or adenomatous. Hyperplastic colon polyps are serrated in nature and rarely become cancerous. Adenomatous colon polyps which can be tubular, tubulovillous, villous, or sessile serrated pose a high malignancy risk and require follow up. Malignant polyps are those that contain cancerous cells.

Colon polyps often occur without any symptoms and are usually detected during colon cancer screening examination, a routine medical examination or tests for another disorder. Symptoms experienced by people with colon polyps include:

• Bleeding from the rectum
• Blood-streaked stools or stools that appear black
• Constipation or diarrhea that lasts for more than a week
• Abdominal pain
• Iron deficiency anemia

Different methods are used to diagnose colon polyps such as colonoscopy, sigmoidoscopy, computerized tomography (CT) scan, and stool tests. If precancerous polyps (adenomas) are detected, a polypectomy is performed to remove them before they become cancerous. Colonoscopy is the considered to ideal option to evaluate the colon as it provides the physician with a view of the entire lining of the colon, allowing the removal most of the polyps detected.

ICD-10 Codes for Colon Polyps

ICD-10 codes for benign adenomatous polyp of the colon – by location – appear in the neoplasm chapter of ICD-10-CM. For correctly assigning the diagnosis code, the documentation should specify:

• • The exact location of the polyps
  • The type of polyps
  • Codes for Benign Colon/Rectal polyps: Current benign colon/rectal polyp is reported using a code from Category D12 Benign neoplasm of colon, rectum, anus and anal canal, which classifies neoplastic polyps according to anatomic location.D12.0 Benign neoplasm of cecum
    D12.1 Benign neoplasm of appendix
    D12.2 Benign neoplasm of ascending colon
    D12.3 Benign neoplasm of transverse colon
    D12.4 Benign neoplasm of descending colon
    D12.5 Benign neoplasm of sigmoid colon
    D12.6 Benign neoplasm of colon, unspecified (includes adenomatous polyp of colon and polyposis of colon)
    D12.7 Benign neoplasm of rectosigmoid junction
    D12.8 Benign neoplasm of the rectum
  • Codes for Inflammatory Polyps: The codes for inflammatory colon polyps appear in Category K51, Ulcerative colitis:K51.40 Inflammatory polyps of colon without complications
    K51.411 Inflammatory polyps of colon with rectal bleeding
    K51.412 Inflammatory polyps of colon with intestinal obstruction
    K51.413 Inflammatory polyps of colon with fistula
    K51.414 Inflammatory polyps of colon with abscess
    K51.418 Inflammatory polyps of colon with other complication

ICD-10 instructs reporting an additional code with category K51 codes to identify manifestations (e.g., pyoderma gangrenosum, ICD-10 code L88).

• Codes to Report other Polyps:
• K63.5 polyp of colon NOS: Code K63.5 is used to report a hyperplastic polyp and is the default code when the type of polyp is not specified as adenomatous/ neoplastic.
• K62.1 Rectal polyp: The ICD-10 code for rectal polyp is K62.
• History of Colon Polyps: If a polyp is discovered in the patient during a colonoscopy and the patient has a family history of colon polyps, AAPC explains that two codes have to be reported:K63.5 and Z83.71 Family history of colonic polyps
• Malignant Neoplasm(s): The ICD-10 codes for malignant neoplasm(s) of the colon and rectum are:C18 Malignant neoplasm of colon
  C19 Malignant neoplasm of rectosigmoid junction
  C20 Malignant neoplasm of rectum

Regular screening is recommended as most colon polyps and early, curable colorectal cancer do not have any symptoms. Colorectal cancer is highly treatable when detected early. Following a healthy lifestyle with regular exercise and a good diet can help prevent colon polyps and colorectal cancer.

Treatment of diseases of the colon and rectum, especially colon cancer, can be complicated. As physicians focus on ensuring high-quality patient care, they can rely on an experienced medical billing and coding company to ensure accurate code assignment and error-free claim submission.

Read our blog post for a comprehensive guide on colonoscopy billing and coding guidelines.