Urology Coding Alert

Hint: You will get a new code for nocturnal polyuria.

The Centers for Medicare & Medicaid Services (CMS) recently released the new ICD-10-CM 2022 codes. You will see two new urology codes this year, plus some coding notes updates. Additionally, you will gain some new T-codes, Z-codes, and a new COVID-19 option.

Editor’s note: These codes will go into effect Oct. 1, 2021.

Dial Into New Polyuria Codes

ICD-10-CM will add a couple of new codes for polyuria, which is excessive urination.

You will gain new code R35.81 (Nocturnal polyuria). This code will also get a new Excludes2 note: nocturnal enuresis (N39.44). “Excludes2 notes codes can be coded with a primary diagnostic code if both diagnoses are clinically present,” according to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Additionally, you will get new code R35.89 (Other polyuria). This code will also include the condition polyuria NOS.

Don’t miss: You will not be able to use code R35.8 (Other polyuria) for polyuria NOS because that condition has been deleted from this code.

Discover Updated Genitourinary System Coding Notes

ICD-10-CM 2022 will also give you some updated coding notes for the genitourinary system.

Code N16 (Renal tubulo-interstitial disorders in diseases classified elsewhere) will see a change to its Excludes1 note. (Emphasis added): Pyelonephritis and tubulo-interstitial nephritis in sicca syndrome [Sjogren’s] Sjogren syndrome (M35.04). As you can see, this is just a minor change to change the wording from sicca syndrome [Sjogren’s] to just Sjogren syndrome.

Excludes1 notes codes are pure excludes, and these diagnostic codes cannot be coded with the primary diagnostic code, Ferragamo says.

Also, you will see a change for “Other diseases of the urinary system (N30-N39).” ICD-10-CM 2022 will delete the Excludes1 note: urinary infection (complicating): abortion or ectopic or molar pregnancy (O00-O07, O08.8) and childbirth and the puerperium (O23.-, O75.3, O86.2-). Instead, this information will become an Excludes2 note.

Next, code N39.44 (Nocturnal enuresis) will gain an Excludes2 note for nocturnal polyuria (R35.81), which is one of the new ICD-10-CM 2022 codes.

Finally, category N97- (Female infertility) will lose the Excludes1 note:female infertility associated with: hypopituitarism (E23.0) and Stein-Leventhal syndrome (E28.2). Instead, this information will become an Excludes2 note.

See New Cannabis T Codes

ICD-10-CM 2022 will add some new T codes. T codes encompass injury, poisoning, and other consequences of external causes.

For poisoning by, adverse effect of, and underdosing of cannabis, you should report the following codes:

• T40.711X (Poisoning by cannabis, accidental (unintentional))
• T40.712X (Poisoning by cannabis, intentional self-harm)
• T40.713X (Poisoning by cannabis, assault)
• T40.714X (Poisoning by cannabis, undetermined)
• T40.715X (Adverse effect of cannabis)
• T40.716X (Underdosing of cannabis)

For poisoning by, adverse effect of, and underdosing of synthetic cannabinoids, you should report the following new codes:

• T40.721X (Poisoning by synthetic cannabinoids, accidental (unintentional))
• T40.722X (Poisoning by synthetic cannabinoids, intentional self-harm)
• T40.723X (Poisoning by synthetic cannabinoids, assault)
• T40.724X (Poisoning by synthetic cannabinoids, undetermined)
• T40.725X (Adverse effect of synthetic cannabinoids)
• T40.726X (Underdosing of synthetic cannabinoids)

Don’t miss: With all of the above codes, you must add a seventh character to indicate the type of patient encounter. Your choices are as follows:

• A — Initial
• D — Subsequent
• S — Sequela

Pinpoint New Covid-19 Option

In 2022, you will gain a new COVID-19 code: U09.9 (Post COVID-19 condition, unspecified).

You will also gain some coding notes with U09.9. For example, code U09.9 enables an establishment of a link with COVID-19, per ICD-10-CM.

Also, you should not report U09.9 in patients that are still presenting with active COVID-19. An exception to this rule is if a patient has a re-infection of COVID-19 that occurs with a condition related to the prior case of COVID-19.

You will also get a new code first note with U09.9. You should first code the specific condition that is related to COVID-19, if it is known. Some examples include the following:

• Chronic respiratory failure — J96.1- (Chronic respiratory failure)
• Loss of smell and taste — R43.8 (Other disturbances of smell and taste)
• Multisystem inflammatory syndrome — M35.81 (Multisystem inflammatory syndrome)
• Pulmonary embolism — I26.- (Pulmonary embolism)
• Pulmonary fibrosis — J84.10 (Pulmonary fibrosis, unspecified)

Mark Down New Z Codes

In 2022, you will also gain some new Z code options. Z codes encompass factors influencing health status and contact with health services. The new codes are as follows:

• Z55.5 (Less than a high school diploma) Note: This code also includes no high-school equivalency diploma (GED).
• Z58 (Problems related to physical environment)
• Z58.6 (Inadequate drinking-water supply) Note: This code also includes lack of safe drinking water.

You will also gain these numerous Z code options for homelessness and housing instability:

• Z59.00 (Homelessness unspecified)
• Z59.01 (Sheltered homelessness) Note: This code also includes doubled up and living in a shelter such as: motel, scattered site housing, temporary or transitional living situation.
• Z59.02 (Unsheltered homelessness) Note: This code also includes residing in place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk and residing on the street.
• Z59.81 (Housing instability, housed) Note: This code also includes foreclosure on home loan, past due on rent or mortgage, and unwanted multiple moves in the last 12 months.
• Z59.811 (Housing instability, housed, with risk of homelessness) Note: This code also includes imminent risk of homelessness.
• Z59.812 (Housing instability, housed, homelessness in past 12 months)
• Z59.819 (Housing instability, housed unspecified)
• Z59.89 (Other problems related to housing and economic circumstances) Note: This code also includes foreclosure on loan, isolated dwelling, and problems with creditors.

In addition, you will get one new code for immunization safety counseling and one for food allergies:

• Z71.85 (Encounter for immunization safety counseling) Note: This code also includes encounter for vaccine product safety counseling. Don’t miss: You should also code the encounter for immunization (Z23) and if the immunization was not carried out (Z28.-).
• Z91.014 (Allergy to mammalian meats) Note: This code includes an allergy to beef, lamb pork, and red meats.

Finally, ICD-10-CM will give you one new code for suicidal behavior and one for nonsuicidal self-harm. They are as follows:

• Z91.51 (Personal history of suicidal behavior) Note: This code also includes a personal history of parasuicide, self-poisoning, and a suicide attempt.
• Z91.52 (Personal history of nonsuicidal self-harm) Note: This code also includes a personal history of nonsuicidal self-injury, self-inflicted injury without suicidal intent, and self-mutilation.

Don’t miss: These new T and Z codes should be useful as informative codes for use in urological coding and should not be used for procedural coding or billing, according to Ferragamo.