Urology Coding Alert

Hint: Think in terms of encounter status for new revisions.

With only a few weeks until the first official update to ICD-10 goes into effect, here’s one last “sneak peek” at the changes you can probably expect to see for urology.

Prostate Codes Gain Specificity

Your diagnosis choices for BPH, dysplasia and similar conditions will expand with several new, more detailed codes.

The changes start with the deletion of N42.3 (Dysplasia of prostate). New codes that will take its place are:

• N42.30 – Unspecified dysplasia of prostate
• N42.31 – Prostatic intraepithelial neoplasia
• N42.39 – Other dysplasia of prostate.

“Adding these specific codes will help us better capture the types of dysplasia seen on prostate biopsy,” says Jonathan Rubenstein, MD, of Chesapeake Urology in Baltimore.

Another deletion will be N50.8 (Other specified disorders of male genital organs). The new replacement codes will be:

• N50.811 – Right testicular pain
• N50.812 – Left testicular pain
• N50.819 – Testicular pain, unspecified
• N50.82 – Scrotal pain
• N50.89 – Other specified disorders of the male genital organs
• N52.35 – Erectile dysfunction following radiation therapy
• N52.36 – Erectile dysfunction following interstitial seed therapy
• N52.37 – Erectile dysfunction following prostate ablative therapy.

Three related diagnoses will see revisions:

• N40.0 will change from Enlarged prostate without lower urinary tract symptoms to Benign prostatic hyperplasia without lower urinary tract symptoms
• N40.1 will shift from Enlarged prostate with lower urinary tract symptoms to Benign prostatic hyperplasia with lower urinary tract symptoms
• N52.39 will change from Other post-surgical erectile dysfunction to Other and unspecified post-procedural erectile dysfunction. 

“In the original version of ICD-10, the N40.0 and N40.1 codes used the term ‘enlarged prostate’ (without and with lower urinary tract symptoms, respectively,” Rubenstein says. “The wording change from ‘enlarged prostate’ to ‘BPH’ was merely to make the term more searchable as BPH is more commonly used in the United States.”

Add ‘Continent’ to Several Urinary Tract Codes

Be careful when reporting problems with urinary tract stoma, because it looks like you’ll have quite a few changes to incorporate. Revisions will include:

• N99.113 will change from Postprocedural anterior urethral stricture to Postprocedural anterior bulbous urethral stricture
• N99.520 will change from Hemorrhage of other external stoma of urinary tract to Hemorrhage of incontinent stoma of urinary tract
• N99.521 will shift from Infection of other external stoma of urinary tract to Infection of incontinent stoma of urinary tract
• N99.522 will shift from Malfunction of other external stoma of urinary tract to Malfunction of incontinent stoma of urinary tract
• N99.528 will update from Other complication of other external stoma of urinary tract to Other complication of incontinent stoma of urinary tract
• N99.530 will update from Hemorrhage of other stoma of urinary tract to Hemorrhage of continent stoma of urinary tract
• N99.531 will change from Infection of other stoma of urinary tract to Infection of continent stoma of urinary tract
• N99.532 will shift from Malfunction of other stoma of urinary tract to Malfunction of continent stoma of urinary tract
• N99.538 will shift from Other complication of other stoma of urinary tract to Other complication of continent stoma of urinary tract.

“There are different types of urinary diversions: generally continent (meaning the patient needs to initiate voiding or catheterize a pouch) versus incontinent (always draining into a bag),” explains Rubenstein. “So the different codes are used to determine the complication in which general type of diversion.” 

This section of codes also will see several new additions. They are:

• N99.115 – Post-procedural fossa navicularis urethral stricture
• N99.523 – Herniation of incontinent stoma of urinary tract
• N99.524 – Stenosis of incontinent stoma of urinary tract
• N99.533 – Herniation of continent stoma of urinary tract
• N99.534 – Stenosis of continent stoma of urinary tract.

“As with all other new ICD-10 diagnostic codes these codes add increased specificity to the various clinical scenarios,” notes Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook.

Plus: The new code options include the potential complications of hemorrhage and stoma, which were not part of the original ICD-10 manual.

Switch Wording for Penile and Testicular Prostheses

Sometimes CPT^® code descriptor changes are so slight you can almost miss them if you don’t pay close enough attention. That’s the case with a series of codes for mechanical breakdown or displacement of penile or testicular prostheses, where the only changes involve a word shift and parentheses.

Example: The existing descriptor for T83.410~ is “Breakdown (mechanical) of penile (implanted) prosthesis … ” with the last character representing the level of encounter (initial, subsequent, or sequela).  Effective Oct. 1, the new descriptor will be “Breakdown (mechanical) of implanted penile prosthesis … .” with the same encounter designation choices for the final character.

Other codes that will follow this structure include:

• T83.420~ -- Displacement (mechanical) of penile (implanted) prosthesis …
• T83.490~ -- Other mechanical complication of penile (implanted) prosthesis … .

Three corresponding code groups will be added to represent the same situations with testicular prostheses. Once again, the seventh character will designate the encounter:

• T83.411~ -- Breakdown (mechanical) of implanted testicular prosthesis …
• T83.421~ -- Displacement of implanted testicular prosthesis …
• T83.491~ -- Other mechanical complication of implanted testicular prosthesis … .

“Again, minor changes in the code descriptors indicate more clearly the clinical circumstances present during a particular urological service,” Ferragamo says.

“We didn’t have specific and unique codes for testicular prosthesis before,” Rubenstein adds. “We would have to use an ‘unspecified’ code or another code that was close to the service.”

Move From ‘of’ to ‘Due to’ for Genitourinary Prosthetic Devices

Another small word change applies to six code groups for problems with genitourinary prosthetic devices. The shift involves changing the descriptor wording from “of” or “from” to “due to.”

Example: You’ll revise T83.81X~, which currently reads, “Embolism of genitourinary prosthetic devices, implants or grafts…” to “Embolism due to genitourinary prosthetic devices, implants and grafts … .”

Other code groups that will see this same change are:

• T83.82X~ -- Fibrosis of genitourinary prosthetic device, implants and grafts …
• T83.83X~ -- Hemorrhage of genitourinary prosthetic devices, implants and grafts …
• T83.84X~ -- Pain from genitourinary prosthetic devices, implants and grafts …
• T83.85X~ -- Stenosis of genitourinary prosthetic devices, implants and grafts …
• T83.86X~ -- Thrombosis of genitourinary prosthetic devices, implants and grafts … .

Pay attention: As noted in previous articles outlining potential changes, some of these codes and/or descriptors might be a little different when the final version of updates is published in October. Based on what we’ve seen so far, however, urology coders can expect to be incorporating changes across the spectrum of diagnoses they often report.