Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders

MS-DRG 391: Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with MCC

MS-DRG 392: Esophagitis, Gastroenteritis & Misc. Digest Disorders without Major Complications or Comorbidity (MCC)

Gastroenteritis is an inflammation of the stomach and the intestines and can cause nausea, vomiting, and diarrhea.  Gastroenteritis has numerous causes, including:

• Infections
  • Viruses
  • Bacteria
  • Parasites
• Food poisoning
• Stress  

Document etiology when it is known or suspected: 

• Infectious
  • Document organism when known or suspected
• Non-infectious, document cause, such as:
  • Radiation or drug induced
    • Specify drug when known
  • Allergic or food hypersensitivity
  • Specify food when known

History should include: 

• Onset, duration, severity, and frequency of diarrhea
• Stool character 
  • Watery
  • Bloody
  • Mucus-filled
  • Purulent
  • Bilious

Documentation to support inpatient care may include one or more of the following: 

• Suspected serve infection (e.g., bloody diarrhea, immunosuppressed) 
• Severe abdominal pain
• Peritoneal signs 
  • Abdominal pain or tenderness
  • Bloating or feeling of fullness in abdomen
  • Fever
  • Diarrhea
  • Loss of appetite
  • Low urine output,   
  • Thirst
• Toxic megacolon
  • Abdominal pain, tenderness
  • Distention
  • Bloody or profuse diarrhea
  • Rapid heart rate (tachycardia) shock
  • Painful bowel movements
• Hemodynamic instability
• Severe or persistent vomiting  
• Severe or persistent dehydration 
• Severe or persistent electrolyte or metabolic abnormality 
• Hemolytic uremic syndrome
• Inability to maintain oral hydration (i.e., needs IV fluid support) 

Esophagitis is inflammation that may damage tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach. Esophagitis can cause painful, difficult swallowing and chest pain. Causes of esophagitis include stomach acids backing up into the esophagus, infection, oral medications and allergies.

• Document acuity: 
  • Acute 
  • Chronic
• Document type:
• Candidal — fungal infection of the food pipe (esophagus), most commonly caused by the yeast Candida albicans
  • Due to GERD (gastro-esophageal reflux disease) /reflux
  • Eosinophilic — chronic immune system disease in which a type of white blood cell (eosinophil) builds up in the lining of the tube that connects the mouth to the stomach (esophagus)
  • Tuberculosis of the esophagus — a secondary disease that occurs as a complication in pulmonary tuberculosis or because of infection from peri bronchial or tracheal lymph nodes.
  • Ulcerative (specify w/bleeding)
• Document any alcohol or drug use, abuse, dependence or past history

When selecting a DRG for Gastroenteritis, check to see if these potential DRGs are more appropriate:

• DRG 377 G.I. Hemorrhage with MCC
• DRG 378 G.I. Hemorrhage with CC
• DRG 379 G.I. Hemorrhage without CC/MCC
  • Review the ICD 10-CM codes for gastrointestinal conditions linked by the terms “with hemorrhage” or with bleeding.” This presumes a causal relationship between two conditions linked by these terms unless the physician documents a different cause of the bleeding.