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Urology Coding Alert

ICD-9 2006 Update:

Hone In on Specific Codes for UTI History, Kidney Failure

Published on Wed May 25, 2005

Starting in October, you'll see more options for coding urinary obstruction

A history of urinary tract infection (UTI) will often prompt a urologist to examine a patient. This frustrates coders, who search ICD-9 in vain for an appropriate diagnosis code. In October, coders' lives will be a little simpler with the addition of some new ICD-9 Codes.

Old way: Now, finding a diagnosis code for a patient with a history of UTI "does present a bit of a problem," says Robert Tait, CPC, coding and billing specialist in the urology department of the Lahey Clinic in Burlington, Mass. Since the patient no longer has the UTI, reporting 599.0 (Urinary tract infection, site not specified) would not be appropriate, he feels. Tait relies on the V13.0x series of ICD-9 codes (Personal history of other diseases; disorders of urinary system) to report UTI history.

New way: According to a proposed rule published in the May 4, 2005, Federal Register, new V codes will appear in ICD-9 2006 to describe a history of urinary tract infection (V13.02) and nephrotic syndrome (V13.03).

Code V13.02 will be a welcomed addition for urologists who re-evaluate patients with treated urinary tract infections, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. Urologists can use V13.02 to help establish medical necessity for
evaluation of patients with a past history of a UTI. Often, a history of UTI is an indication for further tests, but it has been difficult to reflect through coding. "I would consider this code to include past infections such as cystitis, prostatitis, epididymo-orchitis, and pyelonephritis," Ferragamo says.

Expect Enhancements to Kidney Failure Codes

ICD-9 2006 will add seven new fourth digits to code 585 (Chronic renal failure) to describe the different stages of the disease:
 

  •  585.1 - Chronic kidney disease; Stage I
     
  •  585.2 - ... Stage II (mild)
     
  •  585.3 - ... Stage III (moderate)
     
  •  585.4 - ... Stage IV (severe)
     
  •  585.5 - ... Stage V
     
  •  585.6 - End-stage renal disease
     
  •  585.9 - Chronic kidney disease, unspecified.

    ICD-9 code 585 will be an "invalid" code, meaning you will not be able to report it alone, without adding the fourth digit.

    "The renal failure codes add a much needed change to reflect the specificity now made by nephrologists with regard to how far along a patient is toward total failure," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.

    Also new for ICD-9 2006: changes to the unspecified urinary obstruction code. The present code (599.6, Urinary obstruction, unspecified) will be invalid. You will need to choose from one of these four-digit codes: 

  •  599.60 - Urinary obstruction; unspecified
     
  •  599.69 - ... not elsewhere classified.

    Key: These codes take effect on Oct. 1, 2005, says LaWanda Harmon, CPC, coder for the Mississippi Urology Clinic in Jackson. Remember that you no longer have a grace period to begin using new ICD-9 codes.

    To see the complete list of new codes, you can download the proposed rule from the Web site     www.access.gpo.gov/su_docs/fedreg/a050504c.html - click on the "Hospital inpatient prospective payment systems and 2006 FY rates" link under the "Centers for Medicare and Medicare Services" heading. The new codes appear in the back, in tables 6A-6E.

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