Inpatient Facility Coding & Compliance Alert

Question: Urinary retention is on the standard CC list. Can we report it as such when the patient has presented with benign prostatic hyperplasia (BPH)?

Texas Subscriber

Answer: Urinary retention would be your secondary diagnosis. Some secondary diagnoses may act as CCs with a certain diagnosis, but not with others. For a secondary diagnosis to count as a CC, it should consistently have a great impact on hospital resources on its own basis. In this case however, urinary retention would be excluded as a CC since it is an integral part of the clinical presentation of BPH. Its presence by itself does not cause any increase in the demand of hospital resources requisite for this condition.

You can understand CMS’s rationale for putting conditions on the CC exclusion list:

• Chronic and acute manifestations of the same condition.
• Specific and non specific diagnosis codes for the same condition.
• Codes for same condition in sites anatomically close to each other.
• Closely related conditions requiring more or less similar treatment and resources.