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Inflammatory Bowel Disease J009

Document
Last amended 
29 November 2016
Current RMA Instruments
Reasonable Hypothesis SOP 19 of 2012
Balance of Probabilities SOP20 of 2012
Changes from previous Instruments

SOP Bulletin 157

ICD Coding
  • ICD-9-CM Codes: 555, 556
  • ICD-10-AM Codes: K50, K51
Brief description

This is a group of autoimmune systemic inflammatory bowel conditions which comprises chiefly Crohn’s disease and ulcerative colitis.  Additionally, the SOP covers ‘inflammatory bowel disease of unspecified type’. This disease has features of Crohn’s disease and ulcerative colitis but does not fit neatly into either classical subtype (see further comments below).

Confirming the diagnosis

The diagnosis is confirmed by histopathology of a biopsied section of bowel obtained through gastrointestinal endoscopy.  Radiological imaging may also be undertaken.

The relevant medical specialist is a gastroenterologist or general surgeon.

Additional diagnoses covered by SOP
  • Crohn’s disease
  • Ulcerative colitis
  • Regional enteritis
  • Inflammatory bowel disease of unspecified type (this is a specific diagnostic entity)
Conditions excluded from SOP
  • Bowel inflammation secondary to:
    • food allergy,# ICD code 558.9
    • vascular insufficiency,# ICD code 557.9
    • infection,# ICD code 009.0
    • known toxins,# ICD code 558.2 or
    • radiation,# ICD code 558.1
  • Diverticular disease*
  • Irritable bowel syndrome*

* another SOP applies

# non-SOP condition

Clinical onset

Inflammatory bowel disease typically manifests with a gradual onset of gastrointestinal symptoms such as diarrhoea, abdominal pain, weight loss and blood in the stools.  There may also be systemic symptoms such as fatigue and extraintestinal manifestations such as arthritis, eye involvement and skin changes.  Symptoms tend to be episodic. Diagnosis may be delayed.  Once the diagnosis is confirmed the clinical onset may be able to be back-dated to the commencement of relevant symptoms.

Clinical worsening

The course of the disease is highly variable.  Commonly there are exacerbations followed by long periods of complete remission, but with an overall deterioration over time with more extensive and severe disease developing.  A recurrence of active disease after a period of remission will not generally represent a worsening beyond the normal course of the disease.

Comments

Inflammatory bowel disease is a serious condition which causes significant impairment from the disease itself and from the necessary medications (including glucocorticoids) used to treat the disease. The condition can be fatal and can lead to complications of neoplasia.

Ulcerative colitis affects the mucosa of the bowel of the colon, whereas Crohn’s disease affects the full thickness of the bowel wall, and can affect any part of the gastrointestinal tract from the mouth to the anus. In the case of ulcerative colitis the affected bowel segments are contiguous, but in the case of Crohn’s disease, there are several affected segments of bowel with disease free bowel segments interposed.