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Urology Coding Alert

2002 ICD-9 Changes Revise Aftercare Codes

Published on Sun Sep 01, 2002

Updates to the ICD-9-CM codes give urology coders new V codes for follow-up services and a smorgasbord of new genitourinary diagnosis codes.

Beginning Oct. 1, urology coders will be able to use three new V codes V58.42, V58.43 and V58.76 as the primary diagnosis codes for aftercare services rendered to a patient after his or her surgical global period has expired.

For example, a physician performs a circumcision, a procedure with a 10-day global period. The patient returns two weeks after the surgery for a final check on the healing process. Beginning Oct. 1, the primary diagnosis code for payment for this postoperative care will be V58.76 (Aftercare following surgery of the genitourinary system, NEC).

Use V58.42 to designate "aftercare following surgery for neoplasm" and V58.43 to indicate "aftercare following surgery for injury and trauma."

While V58.43 will be used for patients with penile or scrotal injuries (with no late effects), V58.42 is unlikely to be used by urology [coders] very often, says Morgan Hause, CCS, CCS-P. In agreement with Hause, John P. Lavelle, MD, a surgical urologist and assistant professor of urology at the UNC-Chapel Hill Hospital in North Carolina, says V58.42 needs to be more specific for coders to distinguish between encounters that are considered "aftercare" or "follow-up."

For pediatric urology practices, there are three newly valid newborn codes: 771.81 (Septicemia [sepsis] of newborn), 771.82 (Urinary tract infection of newborn) and 771.83 (Bacteremia of newborn). "Prior to Oct. 1, ICD-9 code 771.8 was the code to use for 'other infection specific to the perinatal period,' " says Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas. The new codes "will allow coders to reflect more specifically the infection when it is recorded by the physician," she adds.

Other new urology-related ICD-9-CM codes also to be incorporated Oct. 1 include:

  • 443.23 Dissection of renal artery

  • 445.81 Atheroembolism, kidney

  • 454.8 Varicose veins of the lower extremities, with other complications

  • 459.10 Postphlebetic syndrome without complications.

    You should also bring your ICD-9 coding practices up-to-date by replacing 998.3 (Disruption of operation wound) with the more specific diagnosis codes 998.31, Disruption of internal operation wound; and 998.32, Disruption of external operation wound. An example of proper usage of these codes is to indicate any disruption of an anastomosis in the urinary tract or between the urinary tract and bowel.

    "The further breakdown of operative wound dehiscence (998.3) will make it more important to assign the correct CPT code for closures," Hause says. He says that "using 998.32 would seem to conflict with CPT code 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated)."

    Even though you may use these codes beginning Oct. 1, some carriers, even some Medicare carriers, may not have updated their systems with these new ICD-9 codes. To alert these carriers to the new list of valid and invalid ICD-9-CM codes, refer them to www.cms.hhs.gov/medlearn/icd9code.asp.

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