# urethral damange due to surgery



## Networker3412 (Dec 20, 2010)

What dx code would i use for urethral damanage due to hysterectomy? 997.5? or something else??

Thanks


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## preserene (Dec 20, 2010)

That seems to be closer and E code 870.0


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## btadlock1 (Dec 20, 2010)

867.0 - I _think_...It's Injury to Bladder and Urethra, without mention of open wound into cavity. (Also has a note saying: Tip - Assign for urethral injury due to senile patient's puling out indwelling cather [which I know doesn't exactly apply, here], and another note that says "Unspecified injury of bladder initial encounter") Also, when I looked up Injury, Urethra, the Unspecified listing drected me to this code. The "Bladder* and*" part is what's throwing me off. (I think it's from CPT code definitions - where *and* means *AND*) But I still think this is the best primary code, using the info you've given. It would be helpful to know a little more about the injury, if that information s documented. With more information (like the nature of the injury, and what exactly caused it) I'd be more comfortable assigning a code like the one you mentioned, but I wouldn't want to assign it as a "complication of" something without knowing what it was a complication of. (Catheter? Slip of the knife? etc...)
E878.6 I would think ths E-code is fitting, though, because the category is "Surgical operation and other surgical procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of operation; Removal of other organ (partial)(total) - it's vague enough to apply to any circumstance of injury caused during the hysterectomy, but it clarifies how/when the urethra became injured, slightly. This would probably change, too, with more information, though. Hope that helps!


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## preserene (Dec 20, 2010)

Yes 
867.0  is the best primary code if injures the urethra to its full layers here to open into cavity. If a laceration alone, I think this code would not apply. But during surgery it is only 867.0 could apply logically and analytically. The code 867.1 seems to infer a blunt injury to the cavity which is most unlikely in this scenario. Your code 867.0 is most convincing.

 By the way, I do not find such notes about senility....Where is it at the index?  

I purposely avoided the E878.8 because it is exclusively for without mention of misadventure at the time of procedure. Since that was not presented in the thread and having known that with my practice, the usual occurrence of urethral injury happening during vaginal hysterectomy,  by and large (almost 99.9 percent) identified then and there at the time of procedure. The common is given more value than the very rare occurrence of letting it unnoticed. You are also right if it was unmentioned at the time of surgery.
That is why we get into fix when proper and adequate info not provided to us. Every time we keep asking them to provide with more relevant info.


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## mitchellde (Dec 20, 2010)

No 867.0 is NOT the correct code for this scenario.  That is a code for injury due to trauma.  This is a post op complication and therefore the 997.5 is the correct code, also you need the E code for the complication this will be determined by wheter the complication occured during surgery or if the patient developed the complication during the post op time frame.  If it occurs during surgery then you apply the E code for misadventure during surgery, if durning post op then use the E code for no mention of misadventure.    
Again you need to read all the information presented in the code book for a section or subsection of codes.  Follow the 867 code back all the way until you get to its main sub section and you will see that it specifies a trauma related injury.


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## btadlock1 (Dec 20, 2010)

Yes, a scrubbed report would be best for accurate advice.
The "without mention of misadventure" is also applicable when misadventure is undetermined at the time, but if misadventure was indicated in the note, it would lead to a different E-code, which is worth pointing out.

As for the senility note, it was actually right in my tabular listng under 867.0. That may be something that's unique to Ingenix 2011 books, though!


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## mitchellde (Dec 20, 2010)

Yes since the pulling out of the catheter is a form of trauma to the urethra, but injury during surgery is a surgical complication and is not due to trauma.


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## preserene (Dec 20, 2010)

Michellede a surgically induced trauma/injury can not be taken into the general term "trauma"?
I took it that way and if it can be, then i feel it is more apporpriate primary code instead of going for 99x series as primary. Is in it?. Well as I pointed out the 997.5 is an appropriate  and  more discriptive the cause of injury but as the first listed? (i thouhgt when there is one from  867 series;and the Ecode is a must as i mentioned earlier.  I agree.
The prmary code 867 I felt appropriate because surgical trauma/injury was being taken as trauma by me!
yes i have yet to learn a lot


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## btadlock1 (Dec 20, 2010)

mitchellde said:


> No 867.0 is NOT the correct code for this scenario.  That is a code for injury due to trauma.  This is a post op complication and therefore the 997.5 is the correct code, also you need the E code for the complication this will be determined by wheter the complication occured during surgery or if the patient developed the complication during the post op time frame.  If it occurs during surgery then you apply the E code for misadventure during surgery, if durning post op then use the E code for no mention of misadventure.
> Again you need to read all the information presented in the code book for a section or subsection of codes.  Follow the 867 code back all the way until you get to its main sub section and you will see that it specifies a trauma related injury.



Dang! 997.5 was my first thought, too! I decided against it because I wasn't sure of the extent of damage, and that code seemed to describe something pretty severe.

As for the 867.0, I did actually go back to the chapter heading, and I wasn't able to rule it out by that - it said it included things such as laceration, tear, traumatic rupture, and those all seemed like probable injuries resulting from surgery. I understand that it's specific to injury resulting from trauma, but I honestly didn't see the difference between trauma sustained during/after an operation, and trauma by any other means. Could you please give me an example of what type of situation would be categorized by 867.0, so that I know when it's appropriate to use that type of code? (I mean no disrespect - I genuinely don't know...)

Thanks!


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## mitchellde (Dec 20, 2010)

No problem... Trauma to use the 867.0 code could be like blunt trauma to the pelvic area resulting in internal trauma which could include the urethra.  I have seen this happen in severe assault and accidents, especially bike and mortorcycle.  also sad to say sodomy cases where objects are inserted wich such force.. you get the idea.  for the laceration you can have trauma that lacerates all the way through for an open wound to include laceration of the urethra.  No Preserene this is not the same as surgical injuries which are complications and should be coded as such.  I hope that is helpful.


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## btadlock1 (Dec 20, 2010)

I get it - that makes sense. ICD-9 has way too many codes that have room for interpretation. I hope that ICD-10 will take care of that problem! I'm optimistic...


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