Urology Coding Alert

Plus, ICD-9 proposed changes include 3 new urogynecology codes

Every October, you're faced with new ICD-9 Codes. They take effect Oct. 1, with no grace period, so now's the time to start preparing. Take a look at these proposed changes that you should plan to incorporate into your superbills.

There may be some changes to the list between now and the end of September, but many of 2009's new additions are already available. Although the new codes for this fall contain relatively few changes for urology, Urology Coding Alert homes in on the list of diagnosis code changes most important to you.

Say Goodbye to 599.7

The biggest proposed change for urology is that you'll no longer have ICD-9 code 599.7 (Hematuria, benign, essential) to report. This code is scheduled for deletion on Oct. 1. In its place you will have three new ICD-9 codes:

• 599.70 -- Hematuria, unspecified

• 599.71 -- Gross hematuria

• 599.72 -- Microscopic hematuria.

Good News: Codes Are More Specific

Urology coders will frequently use these new diagnostic codes to properly characterize the degree or severity of the hematuria, experts say.

"I think the biggest diagnosis change for our group will be gross hematuria versus microscopic," says Christy Shanley, CPC, billing manager for the University of California, Irvine, department of urology. "I believe that they will be used frequently in our practice. This is a good change."

"Hematuria is one of the most frequent conditions warranting referral to urology. The more specific coding can be, the better," adds Holly Hayataka, MD, with urology services at The Queens Medical Center in Honolulu, Hawaii. "I believe the new ICD-9 proposals are very good, because the words 'benign' and 'essential' have been deleted. One does not usually know if the hematuria is benign and/or essential until after the complete workup, so 'hematuria, unspecified' is much better."

Update the Kidney Tumor Codes

If your urologist frequently treats kidney problems, starting in the fall you'll be able to be more specific about the type of tumor the patient has. The next ICD-9 update will include two new codes: 209.24 (Malignant carcinoid tumor of the kidney) and 209.64 (Benign carcinoid tumor of the kidney). These codes are "a nice addition," Shanley says. "Prior to these codes, you would have to code by site, benign or malignant." The new codes help you submit "more defined" diagnosis codes, Shanley adds.

Additionally: If you code for urologists involved in the diagnosis and treatment of endocrine abnormalities and abnormal genitalia, take note of the following proposed additions:

• 259.50 -- Androgen insensitivity, unspecified

• 259.51 -- Androgen insensitivity syndrome

• 259.52 -- Partial androgen insensitivity.

This set of changes also provides further definition and specificity to urology diagnosis coding, Shanley says. The new set of proposed ICD-9 changes deletes the prior code you would have used -- 259.5 (Androgen insensitivity syndrome).

"The new 259.5x codes are a good thing," Hayataka says. "It allows coding to capture real life more accurately. There are definitely instances when the partial insensitivity code will be more accurate, usually after the completed workup."

Urogynecology changes: For coders working in the urogynecology discipline, you'll want to take note of three new V codes in the proposed lot of codes:

• V88.01 -- Acquired absence of both cervix and uterus

• V88.02 -- Acquired absence of uterus with remaining cervical stump

• V88.03 -- Acquired absence of cervix with remaining uterus.

Other ICD-9 codes of interest to urologists:

• 199.2 -- Malignant neoplasm associated with transplant organ

• 788.91 -- Functional urinary incontinence

• 788.99 -- Other symptoms involving urinary system.

Deletion: As of Oct. 1, you'll replace 788.9 (Other symptoms involving urinary system) with 788.99.