Urology Coding Alert

ICD-10-CM:

Answer FAQs to Solve all Your Interstitial Cystitis Coding Problems

Published on Mon Jun 13, 2022

Remember to report additional codes.

When a patient has interstitial cystitis, you must check the documentation for numerous details including whether the patient also has hematuria or not.

Answer the following questions to keep your interstitial cystitis claims in tip-top shape.

Observe What Interstitial Cystitis Is

Question 1: What is interstitial cystitis?

Answer: Interstitial cystitis is a long-term chronic inflammation of the bladder wall. Urologists will usually diagnose interstitial cystitis by ruling out other conditions like sexually transmitted disease (STD), bladder cancer, and bladder infections.

You may report an interstitial cystitis code when your urologist documents “A Hunner’s ulcer,” “panmural fibrosis of bladder,” or “submucous cystitis.”

Focus on These Options for Chronic Interstitial Cystitis

Question 2: What ICD-10-CM code should I report for chronic interstitial cystitis?

Answer: You should report with the following codes for chronic interstitial cystitis:

N30.10 (Interstitial cystitis (chronic) without hematuria)
N30.11 (Interstitial cystitis (chronic) with hematuria).

Don’t miss: You’ll choose between codes N30.10 and N30.11 based on whether the patient has hematuria — the presence of red blood cells in the urine.

“For patients with interstitial cystitis, you should look for documentation of hematuria, as code selection is impacted by the presence of hematuria,” explains John Piaskowski, CPC-I, CPMA, CUC, CRC, CGSC, CGIC, CCC, CIRCC, CCVTC, COSC, specialty medicine auditor at Capital Health in Trenton, New Jersey and Surgical Coding Consultant at Memorial Care Health System in Huntington Beach, California.

Other relevant signs and symptoms of interstitial cystitis include severe abdominal pain, prior to voiding with temporary relief on voiding, and severe urinary frequency, adds Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Mind “Additional Code” Notes

Question 3: Does category N30- (Cystitis) have any specific coding notes?

Answer: Yes. Under category N30-, you’ll see “Use additional code to identify infectious agent, which includes categories B95- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere) through B97- (Viral agents as the cause of diseases classified elsewhere).

Urologist Performed Cystourethroscopy? Do This

Question 4: How will my urologist test for interstitial cystitis and how should I report this service?

Answer: Your urologist will use cystourethroscopy to visualize the bladder and perform hydrodistention to test for interstitial cystitis. If your urologist performs the cystourethroscopy with general or spinal anesthesia, you should report 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia).

On the other hand, if the patient is under local anesthetic for the cystourethroscopy, you should report 52265 (... local anesthesia). Your urologist will use distention to see if the patient has mucosal cracking and bleeding, which are suggestive signs for the diagnosis of interstitial cystitis.

Don’t miss: Your urologist will be able to perform most cystoscopic procedures by anesthetizing the urethra with an anesthetic gel or putting the patient under sedation.

Coding tip: When billing services 52260 or 52265, you must use ICD-10-CM codes N30.10 or N30.11 to indicate the potential pathology, Ferragamo says.

Rely on Same Code for Bladder, Installation, Lavage

Question 5: What code should I report if my urologist uses a bladder installation to treat the interstitial cystitis?

Answer: Typical treatment for interstitial cystitis is the instillation of dimethyl sulfoxide (DMSO), sodium hyaluronate, heparin/ lidocaine, sodium bicarbonate, or other “bladder cocktails,” Piaskowski says. You should report 51700 (Bladder irrigation, simple, lavage and/or installation) for bladder installation along with the appropriate HCPCS codes for the medication.

During this procedure, your urologist will use a catheter to fill the patient’s bladder with the bladder cocktail. This cocktail will stay in the patient’s bladder for different amounts of time, depending on the patient’s tolerance to the drugs. The bladder will then be drained through the catheter.

Don’t miss: The descriptor for 51700 also includes “lavage,” which is different from installation. When your urologist lavages, they perform a flushing. On the other hand, with an installation, your urologist will put the drug as treatment into the bladder. Regardless of which of these procedures your urologist performs, you will report 51700.

Don’t Forget to Report Drugs for Bladder Cocktail

Question 6: Which HCPCS codes can I report for the drugs that are used as ingredients in the bladder cocktail?

Answer: You should report the following HCPCS codes along with 51700 when your urologist performs a lavage or installation:

J1212 (Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml)
J1644 (Injection, heparin sodium, per 1000 units)
J2270 (Injection, morphine sulfate, up to 10 mg)
J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg).

PTNS Used to Treat Interstitial Cystitis

Question 7: One of my colleagues mentioned code 64566 as a possible treatment for interstitial cystitis. Could you please explain this code a little more?

Answer: One of the other interesting treatments for interstitial cystitis currently in efficacy trials is neurostimulation of the posterior tibial nerve (PTNS), code 64566 (Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming), which also involves pelvis muscle exercises, Piaskowski says. “PTNS has been used for years to treat urge incontinence and for urinary control. It is now being studied in clinical trials as a treatment of interstitial cystitis and overactive bladder.”