Urology Coding Alert

Here's what you should look for in your physician's documentation.

When ICD-9 Codes becomes ICD-10 Codes in 2013, you will not always have a simple one-to-one relationship between old codes and the new ones. Often, you'll have more options that may require tweaking the way your physician documents a service and a coder reports it.

Check out this common ureteral stone diagnosis, and discover what you'll report after October 1, 2013.

When your urologist treats a ureteral stone, you now apply ICD-9 code 592.1 (Calculus of ureter) to a specific procedure code (such as 52353, Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]).

ICD-10 difference: Instead of relying on one code, 592.1 will expand into four options:

• N13.2 -- Hydronephrosis with renal and ureteral calculus obstruction
• N13.6 -- Pyonephrosis, conditions in N13.0-N13.5 with infection
• N20.1 -- Calculus of ureter
• N20.2 -- Calculus of kidney with calculus of ureter.

Physician documentation: The key difference between the four new codes is the other conditions the patient may also have. When your urologist documents that the patient only has a ureteral stone, you'll report N20.1. You will use N13.2 for a ureteral stone with hydronephrosis and N13.6 for a ureteral stone with hydronephrosis plus infection. If the patient has both a ureteral and a kidney stone, you'll turn to N20.2.

Good news: Your urologist most likely already documents everything needed to choose the proper stone code in 2013.

If the doctor sees evidence of hydronephrosis or a renal stone, he'll document that information. You need to review this information before assigning a specific ureteral stone diagnosis.

Superbill: An updated super bill should list all four codes with an individual check box for each.