Oncology & Hematology Coding Alert

Question: In our oncology practice, I am sometimes called on to code for hematuria, but I am confused about what codes might come into play as there are so many possibilities. How do I distinguish between them?

AAPC Forum Participant

Answer: Coding for hematuria, or blood in the urine, is particularly difficult as it can be a symptom of numerous conditions, including bladder cancer, “an infection, benign (not cancer) tumors, stones in the kidney or bladder, or other benign kidney diseases,” according to the American Cancer Society (www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html). This means your coding depends on whether testing finds a connection between the hematuria and a specific condition.

In oncology, that means you’ll use some of the following:

For the symptom itself report a code from R31.- (Hematuria) such as:

• R31.0 (Gross hematuria) if the blood in the urine is actually visible
• R31.1 (Benign essential microscopic hematuria) for frequent and heavy hematuria that is only visible under a microscope
• R31.21 (Asymptomatic microscopic hematuria) for hematuria that is only visible under a microscope and that is not related to another, more serious condition
• R31.29 (Other microscopic hematuria)
• R31.9 (Hematuria, unspecified)

For patients with sickle cell anemia, you might find N02.1 (Recurrent and persistent hematuria with focal and segmental glomerular lesions) coming into play, as glomerular lesions are typically found in patients with that condition.

For patients with prostate cancer, you’ll follow ICD-10-CM guideline I.C.18.b, which tells you that “codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.”

That means assigning C61 (Malignant neoplasm of prostate) first, followed by the appropriate signs and symptom code, such as R31.0, if the reason for the encounter is the hematuria (for example, if the patient is not able to urinate and can only pass blood as a result of the cancer) per AHA ICD-10-CM Coding Clinic, Volume 4, Number 1, 2017.