Documenting Gastrointestinal Stromal Tumor (GIST) with ICD-10 Codes

Documenting Gastrointestinal Stromal Tumor (GIST) with ICD-10 Codes

Gastrointestinal stromal tumors occur in special cells in the wall of the GI tract. Read this to know about the symptoms, treatment options and ICD-10 codes.

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Gastrointestinal stromal tumor (GIST) is a type of tumor that starts in the wall of the gastrointestinal tract (GI), most commonly in the stomach or small intestine. The tumor is believed to grow from specialized nerve cells found in the GI tract called interstitial cells of Cajal (ICCs), which coordinate the automatic movements of the gastrointestinal tract. Also called the “pacemakers” of the GI tract, ICCs control the digestive process by sending signals related to the movement of food and other liquids through the intestines. GISTs may be malignant (cancer) or benign (not cancer) and can occur anywhere along the length of the digestive tract from the esophagus to the anus. They are most common in the stomach and small intestine but may be found anywhere in or near the GI tract. Reports suggest that approximately 50-70% of all GISTs develop in the stomach, while around 20-30% will arise in the small intestine. The rest arise in the esophagus, colon, and rectum. While documenting gastrointestinal stromal tumor, healthcare practices need to correctly report the symptoms, screening tests and treatment options.

Outsourcing the task to an experienced medical billing and coding company is a feasible strategy, but gastroenterologists should know the rules and document their services appropriately using the right terminology.

According to reports from the American Cancer Society, about 4000-6000 new cases of GISTs are diagnosed in the United States each year. Typically, GISTs can develop in people of all age groups. However, this condition is usually found in adults in the age group of 50-70 years. It is slightly more common in men. GIST appears to occur with increased frequency in patients with a history of neurofibromatosis (NF1 disease). In rare cases, an inherited genetic change (mutation) may also lead to this condition. Potential factors that increase the risk of this condition include older age, genetic syndromes and the presence of neurofibromatosis.

What Symptoms Occur?

Generally, small or early stages of GISTs do not have any specific symptoms as the tumors may grow slowly. On the other hand, people with advanced stages of GISTs need to seek immediate medical attention if they vomit blood or pass blood in their stool due to rapid bleeding from the tumor. Common signs and symptoms of this condition include – 

Weight loss

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Vomiting

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

Nausea

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Loss of appetite

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Feeling full after eating only a small amount (early satiety)

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Fatigue due to anemia (low blood counts)

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Difficulty swallowing

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Blood in stools or vomit

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Anemia, caused by a slow-bleeding tumor

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Abdominal discomfort or pain

How to Diagnosis and Treat GISTs? If a person experiences any of the above symptoms that may indicate the presence of a GIST, he/she should immediately discuss the same with their physician. Physicians as part of the initial diagnosis will perform a detailed physical examination to check for a growth in your abdomen.

Medical history evaluation will be conducted to evaluate symptoms. A wide range of diagnosing imaging tests like – Contrast-enhanced computerized tomography (CT) scan, Positron emission tomography (PET) scan, Colonoscopy (lower endoscopy), Upper endoscopy and Endoscopic ultrasound (EUS) will be performed to locate the type and size of the tumor and to determine the likelihood of spreading (metastasizing) to other organs. Fine-needle aspiration biopsy will also be conducted as part of the diagnosis where in a small sample of tissue from the tumor will be taken and sent for laboratory analysis.

Treatment approach for small, asymptomatic GISTs found in the course of diagnosis involves watchful waiting in carefully selected cases. Common treatment approaches include radiation therapy, chemotherapy, ablation and embolization and targeted drug therapy. However, large or symptomatic GISTs will be surgically removed unless they are too large or they involve too many organs and tissues for surgery (resection). The goal of surgery is to remove the tumor completely. Resection may also be avoided in certain cases wherein the patient’s general health is not good enough for him/her to undergo the procedure.

General surgery medical coding involves the use of specific ICD-10 codes to document any such conditions, including gastrointestinal stromal tumor (GIST). Billable/specific ICD-10-CM codes that can be used to indicate a diagnosis of GIST for reimbursement purposes include –

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

C49.A - Gastrointestinal stromal tumor

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C49.A0 - Gastrointestinal stromal tumor, unspecified site

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C49.A1 - Gastrointestinal stromal tumor, of esophagus

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C49.A2 - Gastrointestinal stromal tumor, of stomach

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C49.A3 - Gastrointestinal stromal tumor, of small intestine

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C49.A4 - Gastrointestinal stromal tumor, of large intestine

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C49.A5 - Gastrointestinal stromal tumor, of rectum

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C49.A9 - Gastrointestinal stromal tumor, of other sites

The earlier the tumor is discovered and treated the better will be the chances of survival. For this reason, people who notice any specific signs or symptoms of GIST should immediately discuss this with their physicians. Treatment for GIST cannot completely remove or destroy the cancerous cells. The chance of recurrence will be high in some cases. Therefore, it is important for patients to undergo regular checkups and other tests to check the growth of cancerous cells.

Choosing the right ICD-10 codes related to the specific condition can be challenging, unless the medical coder has a clear idea about the same. For accurate and timely medical billing and claims submission, healthcare practices can consider outsourcing their medical coding tasks to a professional medical billing company that provides the services of AAPC-certified coding specialists.

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