GERD ICD 10 Coding Guide For Coders

 GERD (Gastroesophageal Reflux Disease) is a medical condition that occurs when stomach acid frequently flows back into the esophagus, causing irritation and damage. In ICD-10, GERD is classified under K21 (Gastro-esophageal reflux disease).

Here are some ICD-10 coding guidelines for GERD:

1. Code K21 is used to classify GERD.
2. Use an additional code to identify any manifestations, such as cough, dysphagia, or heartburn.
3. If the patient has Barrett’s esophagus, the code K22.7 should be used as an additional code.
4. If the patient has a hiatal hernia, the code K44.9 should be used as an additional code.
5. If the patient has a history of GERD but is not currently experiencing symptoms, code Z87.11 should be used.
6. If the patient has both GERD and a gastric ulcer, both codes should be reported.
7. If the patient has both GERD and a peptic ulcer, the code for the peptic ulcer should be sequenced first, followed by the code for GERD.
8. If the patient has both GERD and a gastric or duodenal ulcer, and the physician documents that the two conditions are not related, both codes may be reported separately.

It’s important to accurately code GERD and any related conditions to ensure proper treatment and payment for medical services. It’s recommended that coders consult with a healthcare provider or coding specialist if they have any questions or concerns regarding the correct ICD-10 coding for GERD.