Urology Coding Alert

Find out your weak points now to solve problems before denials roll in.

The October ICD-10 implementation deadline is looming, and despite a small reprieve from CMS on ICD-10 denials, you still need to solidify your diagnosis coding know-how. Last month, Urology Coding Alert presented 10 urology-specific questions to help you practice your ICD-10 coding skills.

What ICD-10 codes did you select for each scenario? Check your answers here.

Diagnosis 1: Staghorn calculus and calculus in bladder

Answer 1: You should report both N20.0 (Calculus of kidney) and N21.0 (Calculus in bladder).

Code N21.0 has an Excludes2 note for staghorn calculus indicating you may report both N21.0 and N20.0 if the documentation shows that both “staghorn calculus” (N20.0) and “calculus in bladder” (N21.0) are clinically present.

Diagnosis 2: Hydronephrosis with infection and stricture

Answer 2: You should report N13.6 (Pyonephrosis).

When your urologist states the patient has hydronephrosis with an infection, an obstruction, or a ureteral stricture you’ll need to learn new codes. With ICD-10, you’ll report one of the following:

• With infection (including obstruction or stricture with infection) — N13.6

• With obstruction by renal or ureteral calculus — N13.2, Hydronephrosis with renal and ureteral calculous obstruction

• With ureteral obstruction or stricture NEC — N13.1, Hydronephrosis with ureteral stricture, not elsewhere classified

Diagnosis 3: Balanoposthitis

Answer 3: You should report N47.6 (Balanoposthitis).

Under ICD-9, you report 605 (Redundant prepuce and phimosis) when your urologist documents that the patient has phimosis. For balanitis, report 607.1 (Disorders of penis: Balanoposthitis, balanitis).

With ICD-10 for other disorders of the prepuce, look for more details. Choose from one of the following codes:

• N47.0 — Disorders of prepuce; Adherent prepuce, newborn

• N47.1— ... Phimosis

• N47.2 — ...  Paraphimosis

• N47.3 — ... Deficient foreskin

• N47.4 — ... Benign cyst of prepuce

• N47.5 — ... Adhesions of prepuce and glans penis

• N47.7 — ... Other inflammatory diseases of prepuce

• N47.8 — ... Other disorders of prepuce.

For patients with balanitis or balanoposthitis, you will choose between N47.6 (Balanoposthitis) and N48.1 (Balanitis).

Diagnosis 4: Hemorrhagic cystitis, hematuria

Answer 4: You should report N30.01 (Acute cystitis with hematuria).

In ICD-9, you need to know the specific type of cystitis the patient has and often the specific location of the inflammation and/or infection.

When ICD-10 goes into effect on Oct. 1, 2015, you’ll still need to look for the same details about the cystitis type and location. However, you will also need to scour the documentation to see if your urologist notes that the patient also has hematuria. If the patient does, your coding will change. (See the chart in Urology Coding Alert, Vol. 16, No. 12 for details about other cystitis ICD-10 codes.)

Diagnosis 5: Bladder cancer of the lateral bladder wall and dome

Answer 5: If the bladder lesions are separate tumors, code for each location: C67.2 for the lateral wall tumor, and C67.1 for the tumor on the dome.

In ICD-10, once you know the patient has a malignant tumor, choose a code from the C67.0-C67.8 categories.

If you have more than one tumor, and these tumors are contiguous and overlapping with each other and the original site of origin cannot be determined, use a subcategory (.8) to indicate the cancer is located in more than one site, said Jonathan Rubenstein, MD, director of coding and physician compliance for Chesapeake Urology Associates in Baltimore, in his CodingCon session “ICD-10 in Urology” in Orlando, Fla.

For example, if your urologist documents contiguous and over lapping tumor from the lateral bladder wall and the dome of the bladder, code C67.8 (Malignant neoplasm of overlapping sites of the bladder), showing that tumor may have originated from more than one site.

Diagnosis 6: Urosepsis

Answer 6: You cannot code a specific diagnosis of “urosepsis” in ICD-10.

In ICD-9 Codes, you have coding conventions to follow, which is to use 599.0 (Urinary tract infection, site not specified) for “urosepsis.” According to ICD-9 guidelines, “The term urosepsis is a nonspecific term. If that is the only term documented then only code 599.0 should be assigned based on the default for the term in the ICD-9-CM index, in addition to the code for the causal organism if known.”

However, ICD-10 eliminates this term. The ICD-10-Manual includes a note to “code to condition,” which means you must query the physician to determine the appropriate code assignment. Specifically, ICD-10 guidelines state:

(ii) Urosepsis The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.

Explain to your urologist that “urosepsis” does not exist in ICD-10. That means your physician should not use that term, unless he wants to be bothered with queries. More specific documentation about this condition is necessary.

Diagnosis 7: Nocturnal enuresis

Answer 7: You should report N39.44 (Nocturnal enuresis).

Take a look at the codes you’ll need to learn to report urinary incontinence under ICD-10:

• N39.3 — Stress incontinence (female) (male)

• N39.41 — Urge incontinence

• N39.42 — Incontinence without sensory awareness

• N39.43 — Post-void dribbling

• N39.44 — Nocturnal enuresis

• N39.45 — Continuous leakage

• N39.46 — Mixed incontinence

• N39.490 — Overflow incontinence

• N39.498 — Other specified urinary incontinence

• R32 — Unspecified urinary incontinence.

Diagnosis 8: Polyuria, urinary frequency, and nocturia

Answer 8: You should report R35.8 (Other polyuria), R35.0 (Frequency of micturition), and R35.1 (Nocturia).

Do not confuse polyuria with urinary frequency. Although urinary frequency may be a clinical symptom of polyuria, report that condition with R35.0 (Frequency of micturition). Also, do not confuse polyuria with nocturia, meaning the patient wakes up at night to urinate. You would report that condition with R35.1 (Nocturia).

Diagnosis 9: Left ectopic testis, right ectopic testis

Answer 9: You should report Q53.02 (Ectopic testes, bilateral).

When your urologist performs an orchiopexy procedure for an undescended testis, you will need to scour your urologist’s documentation to get the details to choose from the following new codes:

• Q53.00 — Ectopic testis, unspecified 

• Q53.01 — Ectopic testis, unilateral 

• Q53.02 — Ectopic testes, bilateral 

• Q53.10 — Unspecified undescended testicle, unilateral 

• Q53.11 — Abdominal testis, unilateral 

• Q53.12 — Ectopic perineal testis, unilateral 

• Q53.20 — Undescended testicle, unspecified, bilateral 

• Q53.21 — Abdominal testis, bilateral 

• Q53.22 — Ectopic perineal testis, bilateral 

• Q53.9 — Undescended testicle, unspecified.

Diagnosis 10: Chronic prostatitis

Answer 10: You should report N41.1 (Chronic prostatitis).

Get your urologist to document the specific information he knows about the patient’s urinary tract infection, and then choose the most specific code you can. Use the chart from Rubenstein, which appeared in Urology Coding Alert, Vol. 17, No. 3.