ED Coding and Reimbursement Alert

Check out these tips on common ED GU presentations

Acute kidney failure and its associated conditions are frequently treated in the emergency department, so it’s highly likely you’ll need to master how to assign an ICD-10 code for this condition. 

Key: ICD-10 instructs coding professionals to code any associated underlying conditions which will require attention to documentation of these elements by emergency physicians says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, Chairman of Edelberg & Associates. 

Although occasionally an ED presentation will be kidney failure resulting from trauma, for example T79.5 (Traumatic anuria), most kidney-related presentations are found in Chapter N of the ICD-10 book, Diseases of the genitourinary system.  Kidney failure is differentiated based on the underlying conditions. Edelberg warns coders to look for documentation of terms such as:

• N17.0 (Acute kidney failure with tubular necrosis), 

• N17.1 (Acute kidney failure with cortical necrosis), 

• N17.2 (Acute kidney failure with medullary necrosis), 

• N17.8 (Other acute kidney failure) and 

• N17.9 (Acute kidney failure, unspecified [non traumatic])

CKD Requires Documentation of the Stage of the Disease As Well

Chronic kidney disease (CKD) requires identification and coding first of associated diabetic chronic kidney disease; hypertensive chronic kidney disease and use of an additional code to identify kidney transplant status if applicable, says Edelberg.  Chronic kidney disease requires documentation and coding of stage as well; (stage 1, stage 2 [mild], stage 3 [moderate]; stage 4 [severe]; stage 5), she adds.

ESRD Has Additional ICD-10 Requirements

If your patient has end stage renal disease defined as chronic kidney disease requiring chronic dialysis (N18.6), you also require documentation and coding of dialysis status (Z99.2).  Chronic kidney disease, unspecified (N18.9) and unspecified kidney failure (N19) are additional classifications in this section that ED coders will use frequently, says Edelberg.

Don’t Feel the Burn Of An Incomplete Cystitis Diagnosis

Cystitis should be coded in addition to the infectious agent (B95-B97) and  requires identification such factors as acute without or with hematuria (N30.00-N30.01), interstitial without or with hematuria (N30.10-N30.11), other without or with hematuria (N30.20-N30.21), trigonitis without or with hematuria (N30.30-N30.31), irradiation without or with hematuria (N30.40-N30.41), other without or with hematuria (N30.80-N30.81) and unspecified without or with hematuria (N30.90-N30.91).

Put Your Finger On The Right Prostate Diagnosis

Prostate conditions (N40.0-N42.0) include enlarged with and without lower urinary tract symptoms, nodular with and without lower urinary tract symptoms, inflammatory disease and other specified and unspecified conditions, warns Edelberg.

Don’t Forget to Code the Infectious Agent in PID Patients

Inflammatory diseases of the female pelvic organs (N70-N77) include numerous classifications commonly treated in the ED.  

Pelvic inflammatory disease requires documentation and coding of the infectious agent (B95-B97).  Unspecified pelvic inflammatory disease, unspecified (N73.9) also requires identification first of any underlying condition when documented.

Bartholin’s cyst (N75.0) and abscess (N75.1) are common ED diagnoses as are excessive, frequent and irregular menstruation (N92).  N92 is differentiated by regular cycle, irregular cycle, puberty, ovulation bleeding and excessive bleeding in the premenopausal periods, Edelberg explains.