Success Codes— GI Edition

Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world-class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminologies below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years ago—and done so with incredible results.


That’s probably why it’s so good—and so good for you!


Now let’s get started.


There are lots of GI conditions associated with increased payments.


You only need to keep in mind five.


Here they are, in the order you’re likely to encounter them:


  • Fecal Impaction (G56.41 RAF 0.3)
    • There is no absolute definition, so document thoroughly.
      • Consider using when you have to order a fecal disimpaction to be performed.
      • Bowel obstruction due to obstipation.
      • Watery diarrhea due to stool blockage.


  • Hepatitis C (B18.2  RAF 0.2)
    • Only code with a corresponding blood test.
    • These patients often drop out of treatment—especially in disadvantaged communities.
    • If you can’t convince them to get treated, at least capture the code routinely so you have the resources available to address their complications.


  • Crohn’s (K50.90 RAF 0.3)
    • Crohn’s can smolder for years, with patients much more likely to rely on the prime for ongoing treatment and never seeing the gastroenterologist until a catastrophic flare.
    • Assess and treat routinely and make sure you capture the code so you can bank resources during quiescent periods against the day of the devastating flare.


  • Ischemic colitis (K55.0 RAF 0.3)
    • A chronic condition that can be symptomatic for years, requiring minimal therapy—until there is a catastrophic complication.
    • Can be diagnosed clinically without endoscopy.
    • Best to tie some sort of imaging evidence of vascular disease to diagnosis—i.e atherosclerosis on plain films.


  • Candidal esophagitis (B37.81 RAF 0.5)
    • Seen but often not explicitly coded by endoscopists.
    • Check your EGD reports systematically as they come across your desk—especially those patients who are immunosuppressed.  It will often pop up as an incidental finding that’s not treated. Common in cancer and dialysis patients especially.


These are your GI Success Codes


Now go out and succeed!









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