Urology Coding Alert

You might be surprised by what you’ll find in the instructions.

Most coders are feeling fairly comfortable with ICD-10 by now, after having more than a year to make initial adjustments and several months to incorporate changes introduced in October 2016. Even as your general comfort level rises, however, it’s not a bad idea to refresh your knowledge of some key components of ICD-10 structure. Focus on three areas to ensure you’re using each section of ICD-10 the way it was intended.

Area 1: Check Notes in the Tabular List

Start your quest for knowledge by remembering to check each level’s ICD-10 notes in the Tabular List before deciding on the final diagnostic code.

Many entries in the ICD-10-CM Tabular List include code-level notes that help you choose the correct diagnosis. But don’t rely on those notes alone; the Tabular List can also point you toward other help, too.

For example: The ICD-10-CM Tabular has instructional notes that appear at other levels too, such as in the front of each chapter, says Marchelle Cagle, CPC, CPC-I, PCS, of Cagle Medical Consulting. You can sometimes miss these additional notes if you rely only on the Tabular code notes.

What to do: Each level may have important instructions, such as Excludes1 and Excludes2 notes, so be sure to check the code, subcategory, category, block, and chapter notes. In a paper manual, you may have to flip pages. An electronic coding resource may post all relevant notes with a code or should at least have clickable links to help you find the information.

Example: When reviewing ICD-10 diagnostic code R33.8 (Other retention of urine). you also find a note of, “Code first, if applicable, any causal condition, such as enlarged prostate (N40.1).” The good news is that if you follow good coding practices and use first the Alphabetic Index and then the Tabular List to search for your code, you will find the correct diagnosis by that approach most of the time. As Cagle notes, the Tabular List is our confirmation of the Alphabetic Index.

Extra resource: The CDC and CMS post a Tabular Addenda each year. The Addenda includes code updates but also includes new, revised, and deleted notes, making it easy to see what’s new for that year’s code set when you’re doing your update prep. You can download the Addenda from www.cdc.gov/nchs/icd/icd10cm.htm.

Area 2: Pull Out the Official ICD-10 Guidelines

After you review the Tabular notes and Tabular Addenda, Cagle recommends that you check out the ICD-10-CM Official Guidelines for Coding and Reporting. Pay particular attention to Section I and Chapter C, she adds.

The Official Guidelines are available at the same link as the Tabular Addenda. Or you can reach the FY2017 Official Guidelines directly at www.cdc.gov/nchs/data/icd/10cmguidelines_2017_final.pdf.

Section I is titled “Conventions, general coding guidelines, and chapter specific guidelines.” Formatting helps you identify what’s new each year:

• Bold indicates narrative changes
• Underline indicates content moved in the guidelines
• Italics indicate heading changes.

Example: The 2017 guidelines bold text in Section I.A.15 where there is a new explanation that you should assume a causal relationship between two conditions linked by the terms with, associated with, or due to in the Alphabetic Index or Tabular List. This addition has an important impact on coding for several specialties, including urology.

Change 1: Section I.C.9.a.2, “Hypertensive Chronic Kidney Disease,” also has a 2017 update clarifying that “CKD should not be coded as hypertensive if the physician has specifically documented a different cause.”

Change 2: You’ll find another revision in I.C.9.a.3, “Hypertensive Heart and Chronic Kidney Disease,” telling you in 2017 to use I13.- (Hypertensive heart and chronic kidney disease) “when there is hypertension with both heart and kidney involvement.” The 2016 version referred instead to “when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis.”

Area 3: Don’t Forget the Index Addenda

You may not expect to see interesting changes in the ICD-10 Index on a regular basis, but it can still hold some valuable information.

CMS and the CDC post an Index Addenda file at the same link as the Tabular Addenda file. A quick review each year is worthwhile. Focus on the additions and revisions, suggests Cagle.