ICD 10 Coding Alert

Don’t forget the possibility that you may need to report additional codes.

Check your knowledge with these seven questions and see whether you can pick up any coding pointers.

Define Interstitial Cystitis

Question 1: What is interstitial cystitis?

Answer: Interstitial cystitis is a long-term chronic inflammation of the bladder wall. Providers will usually diagnose interstitial cystitis by ruling out other conditions like sexually transmitted disease (STD), bladder cancer, and bladder infections.

You may report an interstitial cystitis code when your provider documents “A Hunner’s ulcer,” “panmural fibrosis of bladder,” or “submucous cystitis.”

Understand Nuances of Chronic Interstitial Cystitis

Question 2: What ICD-10-CM code should I report for chronic interstitial cystitis?

Answer: You should report with the following codes for chronic interstitial cystitis:

• N30.10 (Interstitial cystitis (chronic) without hematuria)
• N30.11 (Interstitial cystitis (chronic) with hematuria)

Don’t miss: You’ll choose between codes N30.10 and N30.11 based on whether the patient has hematuria — the presence of red blood cells in the urine.

“For patients with interstitial cystitis, you should look for documentation of hematuria, as code selection is impacted by the presence of hematuria,” explains John Piaskowski, CPC-I, CPMA, CUC, CRC, CGSC, CGIC, CCC, CIRCC, CCVTC, COSC, specialty medicine auditor at Capital Health in Trenton, New Jersey and surgical coding consultant at Memorial Care Health System in Huntington Beach, California.

Other relevant signs and symptoms of interstitial cystitis include severe abdominal pain, pain prior to voiding with temporary relief on voiding, and severe urinary frequency, adds Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Don’t Miss ‘Additional Code’ Notes

Question 3: Does category N30- (Cystitis) have any specific coding notes?

Answer: Yes. Under category N30-, you’ll see “Use additional code to identify infectious agent, which includes categories B95- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere) through B97- (Viral agents as the cause of diseases classified elsewhere).

Do This After Cystourethroscopy

Question 4: How will my provider test for interstitial cystitis and how should I report this service?

Answer: Your provider will use cystourethroscopy to visualize the bladder and perform hydrodistention to test for interstitial cystitis. If your provider performs the cystourethroscopy with general or spinal anesthesia, you should report 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia).

On the other hand, if the patient is under local anesthetic for the cystourethroscopy, you should report 52265 (... local anesthesia). Your provider will use distention to see if the patient has mucosal cracking and bleeding, which are suggestive signs for the diagnosis of interstitial cystitis.

Don’t miss: Your provider will be able to perform most cystoscopic procedures by anesthetizing the urethra with an anesthetic gel or putting the patient under sedation.

Coding tip: When billing services 52260 or 52265, you must use ICD-10-CM codes N30.10 or N30.11 to indicate the potential pathology, Ferragamo says.

Use Same Code for Bladder, Installation, Lavage

Question 5: What code should I report if my provider uses a bladder installation to treat the interstitial cystitis?

Answer: Typical treatment for interstitial cystitis is the instillation of dimethyl sulfoxide (DMSO), sodium hyaluronate, heparin/ lidocaine, sodium bicarbonate, or other “bladder cocktails,” Piaskowski says. You should report 51700 (Bladder irrigation, simple, lavage and/or installation) for bladder installation along with the appropriate HCPCS codes for the medication.

During this procedure, your provider will use a catheter to fill the patient’s bladder with the bladder cocktail. This cocktail will stay in the patient’s bladder for different amounts of time, depending on the patient’s tolerance to the drugs. The bladder will then be drained through the catheter.