ICD-10-CM Coding for ‘Vomiting’ Is Simple, Except When It’s Not

Fri, May 11, 2018 --

ICD-10, Skill Sharpener

Many coders have memorized R11.- (Nausea and vomiting). It’s a common complaint. But did you know that the diagnosis code for cyclical vomiting is in nervous system category G43.- (Migraine)? I was interested to see that when I read a recent Gastroenterology Coding Alert article. In a leap that perhaps only those in healthcare would understand, the discovery made me wonder where else ICD-10-CM puts codes related to the term vomiting. Here’s what I found.

For Cyclical Vomiting, Turn to the Nervous System Chapter

First is the subcategory that started it all, G43.A- (Cyclical vomiting). The subcategory, found in the chapter for diseases of the nervous system, divides into two reportable codes:

  • G43.A0 (Cyclical vomiting, not intractable), which also applies to the kind without refractory migraine
  • G43.A1 (Cyclical vomiting, intractable), which also applies to the kind with refractory migraine.

Term tips: In medicine, intractable and refractory refer to conditions that aren’t easily managed or controlled and don’t respond to treatment.

Travel All Over Based on Index Entries

After learning about G43.A-, I searched the ICD-10-CM index for the term vomiting. Here are the general trends beyond R11.- and G43.A-:

  • Behavioral
    • The index entry for vomiting links several terms, like hysterical, nervous, neurotic, and psychogenic, to F50.89 (Other specified eating disorder), which is in the range for “Behavioral syndromes associated with physiological disturbances and physical factors.”
  • Digestive system
    • When documentation uses the term functional vomiting, the index points you to K31.89 (Other diseases of stomach and duodenum), which is in the digestive system chapter.
    • For patients who recently had GI surgery, look to K91.0 (Vomiting following gastrointestinal surgery).
  • Newborn
    • If the case involves a newborn, check P92.0- (Vomiting of newborn). That’s one of those descriptors that seems like it could be worded better. After writing about ICD-11, I was curious how that code set defined this condition. I think the ICD-11 descriptor could use improvement, too: KD3C (Vomiting in newborn).
  • Entry points you to another entry instead of a code
    • If you look up “asphyxia” under vomiting, the index directs you to see the entry for “Foreign body, by site, causing asphyxia, gastric contents.”
    • For vomiting blood, see hematemesis.
    • Vomiting is expected in patients with uremia, and “uremia” is the index entry you want when you need to code for uremic vomiting,

Final tip: If you have a specific diagnosis, remember to check that term in the index rather than starting with the “vomiting” entry. For instance, hyperemesis gravidarum, which falls under category O21.- (Excessive vomiting in pregnancy), is not listed under the vomiting entry in the ICD-10-CM index. If you use an online coding solution that includes keyword search beyond exact index entries, you may find the correct code there, too.

What About You?

Do you know of any diagnoses of procedure codes that are in unexpected places in the code set?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

, , ,

Leave a Reply