Urology Coding Alert

Make sure to look beyond the new, revised, and deleted codes.

Continuing education is a necessary prerequisite if you want to maintain your status as a compliant and equally efficient coder. This involves staying on top of all the incoming authoritative guidance in addition to the annual updates to the respective code books. For ICD-10-CM, you should typically expect to get your first taste of new, revised, and deleted codes a little over two months before the implementation.

This year proves no exception — and there are plenty of important coding changes for you to digest that are specific to urology.

Keep reading to get your feet wet with the most essential ICD-10-CM coding changes for the 2021 calendar year (CY).

See What’s New With CKD Coding

While some of the most prevalent changes in 2021 come by way of ICD-10-CM code revisions, there are a few key code additions you should take note of. First, chronic kidney disease (CKD) diagnosis coding gets an overhaul with more specificity added for stage 3 CKD patients. Consider the following new codes:

• N18.30 (Chronic kidney disease, stage 3 unspecified)
• N18.31 (Chronic kidney disease, stage 3a)
• N18.32 (Chronic kidney disease, stage 3b)

When CKD is not documented with any further specificity beyond stage 3, you’ll revise your coding from N18.3 to N18.30. Stages 3a and 3b are based on a patient’s estimated glomerular filtration rates (eGFRs):

• 3a — eGFR between 45 and 59 ml/minute
• 3b — eGFR between 30 and 44 ml/minute

Keep in mind that the documentation does not need to identify stage 3a or 3b for you to report N18.31 or N18.32. So long as you have documentation in the patient’s chart of the documented eGFR, you may code to the respective CKD substage.

Check Out Updated Coding for N02-N07, Obstetrical Pelvic Complications

Another important set of new codes to add to your coding arsenal pertains to nephritis diagnoses with C3 glomerulonephritis or C3 glomerulopathy. First, get acquainted with the following new code within the N02 (Recurrent and persistent hematuria) category: N02.A (Recurrent and persistent hematuria with C3 glomerulonephritis).

Consider a few more new sets of codes falling within category code ranges N03-N07:

• N04.A (Nephrotic syndrome with C3 glomerulonephritis)
• N05.A (Unspecified nephritic syndrome with C3 glomerulonephritis)
• N06.A (Isolated proteinuria with C3 glomerulonephritis)
• N07.A (Hereditary nephropathy, not elsewhere classified with C3 glomerulonephritis)

“Keep in mind that most of the new and revised ICD-10-CM codes above relate to medical, as opposed to surgical diseases of the kidney and urinary tract,” explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York Stony Brook. “These ICD-10-CM codes will be documented more often by a nephrologist than a urologist. However, the urologists should be aware of these diagnoses when they deal with both medical and surgical diseases in the same patient,” Ferragamo advises.

Finally, round out your knowledge with one final set of three new obstetrical complication codes:

• O99.891 (Other specified diseases and conditions complicating pregnancy)
• O99.892 (Other specified diseases and conditions complicating childbirth)
• O99.893 (Other specified diseases and conditions complicating puerperium)

While you may initially consider these codes to be exclusively relevant to the ob-gyn specialty, these codes will be reported for any obstetrical patients treated by a urologist for pelvic complications during or following childbirth. For instance, beginning in October, you’ll report code O99.891 when the urologist treats a patient for pelvic inflammatory disease and peritoneal (pelvic) adhesions during pregnancy.

Dive Deeper Than Just New ICD-10-CM Codes

If you want to get the most out of the ICD-10-CM updates, you must look beyond the mere addition of new codes. “Many coders think if they review their new ICD-10-CM book, focusing on ‘new code’ icons, they will be alerted to all the changes in the ICD for the year; nothing could be further from the truth,” says Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.

Bernard goes on to explain that a review of the 2021 ICD-10-CM Alphabetic Index addendum is essential to understanding all the changes to ICD-10-CM year over year. For instance, there are some circumstances where the index reroutes terms and sub terms from one code to another.

Example: One example of this that’s relevant to urology has to do with a doubling of the uterus diagnosis. In the 2020 ICD-10-CM, Double ⇒ uterus would yield code Q51.20 (Other doubling of uterus, unspecified). Beginning on October 1, 2020, you’ll find that same index look-up results in Q51.28 (Other doubling of uterus, other specified). “As you can see, no codes changed, just the classification of a diagnosis from one code to another,” explains Bernard.

Touching further on the subject of 2021 revisions, you will want to incorporate two additional code revisions regarding diagnoses of renal glycosuria in addition to some obstetrical pelvic inflammatory complications. First, you’ll see that glycosuria ⇒ renal will be revised from E74.8 (Other specified disorders of carbohydrate metabolism) to a new code in the E74.81- subcategory.

Another set of changes that doesn’t fall into one of the new, revised, and deleted code categories has to do with the addition of index terms for existing codes. In some instances, you’ll now find more sub terms that lead to some existing codes. One example in 2021 ICD-10-CM pertains to code N20.1 (Calculus of ureter). You can now reach this same code in the Alphabetical Index by searching for Calculus, calculi, calculous ⇒ ureteropelvic junction. Prior to this new index term, calculus at the ureteropelvic junction would technically only qualify for code N20.9 (Urinary calculus, unspecified).

Coder’s note: Make sure you scour the ICD-10-CM Tabular changes for all the important parenthetical note changes. These include new and revised Excludes1, Use Additional, and Code Also notes.