Urology Coding Alert

Check the urologist's documentation for mention of infection to start down the right code path.

When your urologist documents that a patient has hydronephrosis, you report 591 (Hydronephrosis) -- which may include any or all of the following clinical scenarios: early hydronephrosis, hydronephrosis with an atrophic kidney, a functionless and infected kidney, intermittent hydronephrosis, or a primary or secondary type of hydronephrosis.

When ICD-9 becomes ICD-10 in 2013, you'll still have one diagnosis code for atrophic, early, functionless, intermittent, primary, and secondary not elsewhere classified (NEC) hydronephrosis: N13.30 (Unspecified hydronephrosis). For other specified types of hydronephrosis NEC, you'll use N13.39 (Other hydronephrosis).

ICD-10 difference: When your urologist states the patient has hydronephrosis with an infection, an obstruction, or a ureteral stricture you'll need to learn new codes. With ICD-10, you'll report one of the following:

When your urologist documents that a patient has congenital hydronephrosis, you have a one-to-one ICD-9 to ICD-10 code exchange. In ICD-9 you report 753.29 (Obstructive defects of renal pelvis and ureter, other) and in ICD-10 you'll use Q62.0 (Congenital hydronephrosis).

For hydronephrosis associated with tuberculosis, you'll exchange ICD-9 code 016.0x (Tuberculosis of genitourinary system, kidney ... ) for ICD-10 code A18.11 (Tuberculosis of kidney and ureter).

Physician documentation: The physician should be documenting the type of hydronephrosis the patient has as well as whether there are infections, stones, or strictures associated with the hydronephrosis. This won't change in 2013. You'll just need to be more diligent in looking for those extra details when you're selecting the proper diagnosis code to report.