Pediatric Coding Alert

Answer: This can be tricky, because UTIs go by different names, depending on their location in the body. They typically occur in the kidneys (pyelonephritis), the bladder (cystitis), or the urethra (urethritis). To choose the appropriate diagnosis code, you’ll need to know the specific site and which ICD-10 code describes the correct type of UTI. Diagnosis code choices include the following:

• N10 (Acute pyelonephritis)
• N30.- (Cystitis)
• N34.- (Urethritis and urethral syndrome)
• N39.0 (Urinary tract infection, site not specified)
• N99.521 (Infection of incontinent external stoma of urinary tract)
• N99.531 (Infection of continent stoma of urinary tract)

Pay attention: Because the N99 codes are complication codes, they require physician documentation and confirmation of a cause-and-effect relationship between any specified procedure and the complicated condition. “These types of diagnosis codes assist in describing additional conditions that may add to the initial urinary tract infection. The infection of a stoma could be a reason for the infection in the urinary tract. Make sure the documentation includes this information,” says Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coder and consultant in Glen Burnie, Maryland.

Here are two helpful tips for how to choose the appropriate option from the above-mentioned UTI codes:

1: Remember the difference between acute (sudden, short-term) and chronic (persistent). For instance, if the patient has acute cystitis, you’ll report N30.0- (Acute cystitis); but if the patient’s cystitis is chronic, you’ll report N30.1- (Interstitial cystitis (chronic)) or N30.2- (Other chronic cystitis). Also remember that the physician is the only one who can decide whether any condition is acute or chronic.

2: Based on the ICD-10 note accompanying N10, N30, N34, and N39.0, you will need to use an additional code from B95.- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere) through B97.- (Viral agents as the cause of diseases classified elsewhere) to identify the infectious agent, if applicable. The infectious organism identification will depend on the results of a lab test such as a urine culture 87086 (Culture, bacterial; quantitative colony count, urine) or 87088 (Culture, bacterial; with isolation and presumptive identification of each isolate, urine) for presumptive identification; or 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate) for definitive identification. “Most coders forget to include the additional code to identify the bacteria causing the infection. Make sure the results of the urine culture/ sensitivity are documented as well,” says Stinchcomb Storck.