Postoperative Ileus

Coding Clinic, 1^st Quarter 2017: Page 40

Effective with discharges March 13, 2017

• Since an ileus can either be obstructive or non-obstructive, Coding Clinic advises that coders cannot assume that a postoperative ileus is obstructive
• To assign the correct ICD-10 code, documentation must be clear as to whether the ileus is related or unrelated to surgery and if it is obstructive (mechanical) or non-obstructive (paralytic)
• Paralytic (non-obstructive or pseudo-obstruction) causes include: abdominal surgery, decreased blood supply to the intestines, and infections such as appendicitis
• Mechanical (obstructive) causes include: adhesions, hernias, and impacted stools
• Coding Clinic recommends the following ICD-10 codes for documentation of:
  • Ileus due to surgery (non-obstructive)
    • K91.89 (Other postprocedural complications and disorders of digestive system)
    • K56.7 (Ileus, unspecified)
  • Ileus due to surgery (obstructive)
    • K91.3 (Postprocedural intestinal obstruction)
  • Ileus unrelated to surgery (non-obstructive)
    • K56.7 (Ileus, unspecified)
  • Ileus unrelated to surgery (obstructive)
    • K56.69 (Other intestinal obstruction)
• If documentation is unclear, Coding Clinic recommendations that a query is sent to the provider