ED Coding and Reimbursement Alert

Question: We’ve been reporting N39.0 (Urinary tract infection, site not specified) for urinary tract infections (UTIs). The “site unspecified” verbiage in the descriptor has always been confusing since the site is always the urinary tract. But now our coding director is saying we need to get more specific. How?

Answer: Even though N39.0 does describe urinary tract infections (UTIs), landing on the right code for a UTI diagnosis is not necessarily clearcut. Remembering that specificity is crucial for accurate coding is always important, and UTIs are no exception, particularly since UTIs can occur in the kidneys, bladder, and other areas.

First, the lack of specificity in N39.0 presents a real problem for reimbursement because the industry is moving toward diagnostic-based

Depending on provider documentation, you could use one of the following before you can pinpoint the specific diagnosis:

• R30.- (Pain associated with micturition)
• R32 (Unspecified urinary incontinence)
• R33.- (Retention of urine)
• R35.- (Polyuria)
• R39.1- (Other difficulties with micturition)
• R82.81 (Pyuria)

But once your provider pins down the specific UTI, you will move to other, more specific codes.

After the provider makes a formal UTI diagnosis, you should use the specific site if known. Consider this chart as you understand the different locations where UTIs might occur:

For the N30.- codes, you will also have to pay close attention to your provider’s note to see if the patient has been diagnosed with acute (sudden) or chronic (persistent) cystitis. If your physician documents the patient with acute cystitis, you’ll report N30.0- (Acute cystitis), but if the documentation states chronic cystitis, you’ll report N30.1- (Interstitial cystitis (chronic)) or N30.2- (Other chronic cystitis).