Urology Coding Alert

Start by exploring catheter, genitourinary hemorrhage, and diagnostic imaging updates.

October will bring the first official updates to ICD-10, but information about proposed changes has already been circulated. Thousands of additions, revisions, and deletions are in the latest file, though other changes might still be made prior to the Oct. 1, 2016, implementation.

Your diagnosis coding will be affected by many of the changes, ranging from catheters and stents to implants, diagnostic imaging, and more. Read on for your first look at three areas with important updates.

Area 1: Catheter Codes See Multiple Changes

Nearly 50 of the proposed code updates pertain to urinary, urethral, or nephrostomy catheters. Each new diagnosis expands to three possibilities based on encounter status (initial, subsequent, or sequel). The proposed new base codes for these conditions are as follows:

• T83.011~ – Breakdown (mechanical) of indwelling urethral catheter …
• T83.012~ – Breakdown (mechanical) of nephrostomy catheter …
• T83.021~ – Displacement of indwelling urethral catheter …
• T83.022~ – Displacement of nephrostomy catheter …
• T83.031~ – Leakage of indwelling urethral catheter …
• T83.032~ – Leakage of nephrostomy catheter …
• T83.091~ – Other mechanical complication of indwelling urethral catheter …
• T83.092~ – Other mechanical complication of nephrostomy catheter ….

“These are new ICD-10 codes describing complications that frequently may occur,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook. As such, you’ll probably find yourself being glad to have them in your coding mix.

Revisions to diagnoses related to catheters all have the same two changes: the deletion of the word “indwelling” from the descriptor and a shift from the term “urethral” to “urinary.”

For example, the current base diagnosis T83.018~ will change from “Breakdown (mechanical) of other indwelling urethral catheter” to “Breakdown (mechanical) of other urinary catheter.” Other codes following this new structure include:

• T83.028~ – Displacement of other urinary catheter …
• T83.038~ – Leakage of other urinary catheter …
• T83.098~ – Other mechanical complication of other urinary catheter … .

As with the diagnoses listed above, the seventh character will represent the encounter status: A for initial, D for subsequent, or S for sequela.

Take note: These new ICD-10 codes will now include all urinary catheters whether urethral, bladder, ureteral, or renal.

Area 2: Genitourinary Hemorrhage Codes Get More Refined

A few small changes to descriptors for postprocedural hemorrhage of a genitourinary system structure will help your coding be more specific.

In the original ICD-10 manual, diagnoses N99.820 and N99.821 represented both postprocedural hemorrhage and hematoma after the procedure. Anticipated revisions to the codes in October will give you updated descriptors:

• N99.820 – Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure
• N99.821 – Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure.

New additions: You’ll now have separate codes when the patient experiences a postprocedural hematoma in those situations:

• N99.840 – Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure
• N99.841 – Postprocedural hematoma of a genitourinary system organ or structure following other procedure.

Area 3: Diagnostic Imaging Adds More Details

If the proposed updates stand, you will no longer have R93.4 (Abnormal findings on diagnostic imaging of urinary organs) as a diagnostic option. Instead, you’ll have five new codes that will allow you to use more specific coding:

• R93.41 – Abnormal radiologic findings on diagnostic imaging of renal pelvis, ureter, or bladder
• R93.421 – Abnormal radiologic findings on diagnostic imaging of right kidney
• R93.422 – Abnormal radiologic findings on diagnostic imaging of left kidney
• R93.429 – Abnormal radiologic findings on diagnostic imaging of unspecified kidney
• R93.49 – Abnormal radiologic findings on diagnostic imaging of other urinary organs.

These new radiological ICD-10 codes are now organ specific and add laterality to the diagnoses,” Dr. Ferragamo points out. This isn’t unusual, considering the emphasis ICD-10 has already placed on laterality coding.

Coming next month: A look at changes to your diagnoses for urinary stent displacement or breakdown, among others.