ICD 10 Coding Alert

Don’t confuse stress incontinence with other types of voiding.

Coding incontinence require vigilance because there are several categories of incontinence — and coders need to know the ICD-10-CM specifics for every kind.

Plus, government payers are using some extra scrutiny on claims involving incontinence.

The background: The Centers for Medicaid & Medicaid Services (CMS) has listed sacral nerve stimulation for urinary incontinence as an Approved Issue for its Recovery Audit Contractors (RACs) to review (https://www.cms.gov/Research- Statistics-Data-and-Systems/ Monitoring-Programs/Medicare- FFS-Compliance-Programs/Recovery-Audit-Program/ Approved-RAC-Topics). Plus, in the past, the Office of Inspector General (OIG) has listed both biofeedback and pelvic floor therapy for incontinence on its Work Plan, and they may do so again in the future.

The bottom line is that the government is looking for justification before paying incontinence services, and the best way you can prove medical necessity is by submitting the most accurate diagnosis codes.`

Check out a few terminology clues that can help you select the perfect ICD-10-CM diagnosis code for incontinence every time.

Distinguish Stress Incontinence From Overactive Bladder

Some of the services your provider may recommend for incontinence patients may be covered for diagnoses in the incontinence category but not for the more general “overactive bladder” diagnosis, so you must be able to differentiate these conditions before you choose the right code.

• N39.3 (Stress incontinence (female) (male)) describes a patient’s inability to retain urine when a stressor occurs. Those stress triggers might include laughing, sneezing, jumping, coughing, or lifting heavy items. This condition is typically more common in females, but the same code applies no matter which gender the provider treats.
• N32.81 (Overactive bladder) describes a patient’s sudden, frequent need to urinate. The patient may or may not be incontinent due to this condition, so you should never assume that a patient with overactive bladder is also incontinent.

Not only can N32.81 not take the place of N39.3, but the codes should be coded together when applicable. A note in the ICD-10-CM code book under N39.3 advises coders to also report an associated overactive bladder when warranted. Therefore, a claim for an overactive bladder patient who has stress incontinence would include:

• N39.3
• N32.81

Understand Urge Incontinence

Another term you might see in your provider’s documentation is “urge incontinence.” This describes the patient’s sudden urge to urinate, which they do before they’re able to make it to the toilet. It comes on quickly and can happen during day or night and is caused by the bladder contracting. It’s not triggered by a specific external event as stress incontinence is.

To report this diagnosis, you’ll submit:

• N39.41 (Urge incontinence)

The one major similarity between coding stress incontinence and urge incontinence is that N39.41 also has a note under it indicating that you should “Code also any associated overactive bladder (N32.81).” Therefore, patients with both overactive bladder and urge incontinence would have claims submitted with:

• N39.41
• N32.81

Look to N39.42 for Incontinence Without Sensory Awareness

When the provider documents incontinence without an awareness that urination is about to happen, that’s referred to as “incontinence without sensory awareness.” The patient may not know they need to urinate due to being on certain medications, having dementia/Alzheimer’s, being disabled (such as having a spinal cord injury), or a variety of other issues.

If you see this condition documented in the medical record, you’ll report:

• N39.42 (Incontinence without sensory awareness)

A note after this code indicates that N39.42 also describes insensible urinary incontinence, so if the provider documents that condition, you’ll report N39.42.

As with the codes above, you’ll report any associated overactive bladder with N32.81.

Define Post-Void Dribbling

In some instances, patients will urinate, but then will expel another small amount of urine immediately thereafter. This condition is more common in males than in females, but it can affect either gender. To report post-void dribbling, you’ll report:

• N39.43 (Post-void dribbling)

If the patient also has overactive bladder, report N32.81 after you list N39.43.

Pocket These Additional Incontinence Diagnoses

Although the above codes describe some of the more common incontinence diagnoses most urology practices see, you may also encounter the following conditions associated with the inability to retain urine:

• N39.44 (Nocturnal enuresis): This occurs when patients urinate while sleeping and are beyond the age when bedwetting is common.
• N39.45 (Continuous leakage): Patients who have weak bladders or nonfunctional pelvic floor muscles may leak urine throughout the day and night, a condition also referred to as continuous leakage.
• N39.46 (Mixed incontinence): In some cases, patients experience both stress incontinence and urge incontinence. This is described as “mixed incontinence.” For these patients, you’ll report this code rather than submitting both N39.3 and N39.41.
• R39.81 (Functional urinary incontinence): If a patient can’t get to the toilet on time due to circumstances outside of the urinary system, this is known as functional incontinence. For instance, a patient may be in too much pain to get out of their wheelchair in time to make it to the bathroom, or perhaps they have a disability like arthritis that prevents the ability to unbutton their pants fast enough and keeps them from making it to the bathroom quickly enough.
• R32 (Unspecified urinary incontinence): When patients have incontinence but you can’t find enough information to select a more specific ICD-10-CM code, you should report R32.
• F98.0 (Urinary incontinence of nonorganic origin): When the patient has incontinence that can’t be attributed to an anatomic or physiologic cause, this code may apply.

Query When Appropriate

Coders who have been accustomed to reporting the same one or two codes for incontinence may be surprised to see so many options available for this condition. What’s important is to never assume that documentation of “incontinence” refers to one specific code — like stress or urge — just because you’ve seen those diagnoses so often.

If the provider doesn’t give you a specific diagnosis and you can’t evaluate the etiology by reading the patient’s chart, you should always query the provider for additional information.

Torrey Kim, Contributing Writer, Raleigh, N.C.