Pediatric Coding Alert

ICD-10 offers fairly simple conversion for urinary tract infections.

Urinary tract infections (UTIs) account for more than one million visits to pediatricians’ offices annually, with more girls getting these infections than boys, according to the National Kidney and Urologic Diseases Information Clearinghouse. This means your practice is undoubtedly seeing these conditions on a weekly basis. But if you’re unclear on how you’ll bill these diagnoses when ICD-10 is implemented, read on to get the scoop about ICD-10 coding for this common condition.

ICD-9 Coding Rules: Under ICD-9 rules, a urinary tract infection related to an unspecified site should be coded with 599.0 (Urinary tract infection, site not specified). Typically, this is what pediatricians most often diagnose for younger patients. 

In some cases, the physician may diagnose the patient with acute cystitis (595.0, Acute cystitis), which is a urinary tract infection of the lower tract. In other situations, the pediatrician may find that a patient has pyelonephritis, an infection of the upper tract 9), most often in infant patients, which you’ll typically report with 590.10 ().

ICD-10 Changes: When the ICD-10 transition takes place, your unspecified-site urinary tract infection coding option will enjoy a one-to-one crosswalk, with N39.0 (Urinary tract infection, site not specified) debuting as the go-to code for this condition. 

If the physician finds acute cystitis, your coding options will expand out to two codes, as follows:

N30.00 (Acute cystitis without hematuria)

N30.01 (Acute cystitis with hematuria)

Clearly, selection of an acute cystitis code will hinge on whether the patient suffered from hematuria, which is the presence of red blood cells in the patient’s urine sample. 

And your pyelonephritis coding may be more challenging since the descriptor has been changed and no longer has the word “pyelonephritis” in it. However, under the descriptor for new code N10 in the ICD-10 manual, you’ll find that the code does include acute pyelonephritis N10 (Acute tubulo-interstitial nephritis).

Documentation: The biggest documentation adjustment will be that if the patient has acute cystitis, you must include a note indicating whether or not the patient had hematuria. Often, the physician will write this in the documentation, and in addition, you will typically find a laboratory report in the documentation indicating the presence of red blood cells (hematuria) in the urine. 

Coder Tips: Next to “acute cystitis” on your superbill, leave a space where the physician can indicate whether or not the patient had hematuria. For instance, you could either list both codes, as follows:

N30.00 (Acute cystitis without hematuria)

N30.01 (Acute cystitis with hematuria)

Or you could list one and then have the pediatrician circle hematuria when indicated:

N30.0x - Was hematuria found? YES      NO.