Primary Care Coding Alert

Question: A 28-year-old established patient reports to the FP complaining of burning during urination and kidney pain. After a level-two E/M, the FP orders a bacterial urine culture. Notes indicate that the patient had blood in urine, unseen with naked eye. What diagnosis code best represents this condition?

Texas Subscriber

Answer: It sounds like the FP diagnosed microscopic hematuria (599.72); use this diagnosis when the patient has blood in the urine that is not visible without a urine test. This is a new ICD-9 code for 2009, so you might have overlooked it. On the claim, report the following:

" 87086 (Culture, bacterial; quantitative colony count, urine) for the urine culture

" 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) for the E/M

" modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99212 to show that the E/M and culture were separate services

" 599.72 appended to 87086 and 99212 to represent the patients condition.

In addition to 599.72, there are two other new hematuria codes: 599.70 (Hematuria, unspecified) and 599.71 (Gross hematuria). Report 599.71 when notes indicate the patient has visible blood in her urine.