Urology Coding Alert

Bonus: You'll also have several new pain management codes to support your urologist's services

You'll have two new urinary symptom codes, several revised kidney disease codes, and a new code for torsion of testis, thanks to the ICD-9 update that will take effect on Oct. 1, 2006. Our experts weigh in on which changes will have the biggest effect on your practice's claims.

Add Specificity With New Urinary Symptom Codes

When a patient presents with difficulty urinating, coders are challenged to find an appropriate ICD-9 code to represent this symptom. In October, coders' lives will be a little simpler with the addition of some new ICD-9 codes.
 
New options: The next round of updated ICD-9 codes will offer two new urinary symptom codes: 788.64 (Urinary hesitancy) and 788.65 (Straining on urination).
 
Old way: Urology coders will benefit from the addition of 788.64 and 788.65, two conditions that were previously not listed, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio. You've been forced to report these symptoms with 788.9 (Other symptoms involving urinary system), but staring in October you'll have more specific options.
 
Example: Patients frequently complain of urinary hesitancy and straining on urination when they have an outflow obstruction due to bladder neck contraction, says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook.
 
For the outflow obstruction condition, you'll report 596.0 (Bladder neck obstruction) along with 600.01 (Prostatic hyperplasia) and 598.9 (Urethral stricture, unspecified). Now you can also prove medical necessity for E/M services your urologist provides based on these two new diagnosis codes representing the urinary hesitancy and straining on urination.

Avoid 608.2 After Oct. 1

The ICD-9 2007 changes will delete diagnosis code 608.2 (Torsion of testis). In its place you'll find five new torsion codes, 608.20 (Torsion of testis, unspecified) to 608.24 (Torsion of appendix epididymis). 
 
In a patient with testicular torsion, you now have several anatomic variations to correctly delineate the urologist's findings when he performs an exploration, thanks to the new codes, Ferragamo says. A more exact anatomic description of the surgical findings is possible and should ensure proper payment for any emergency surgical procedures the physician performs, he adds.
 
Bonus: Take a look at the chart on page 47 to review the other new torsion codes and to see the rest of the ICD-9 revisions, deletions and additions that will affect your urology coding.

Add Several New Pain Codes to Your Arsenal

You'll soon have new, specific codes to use when your urologist sees a patient for pain, for example, postoperative pain. ICD-9 2007 offers a new series of eight pain codes (338.0-338.4) that will be useful, especially when you're reporting postoperative pain management.
 
"The section 338.0-338.4 will be useful to allow for more accurate coding of pain," Vogelberger says.
 
Example: A patient presents at your office with persistent pain after surgery. He's outside of the 10-day global period associated with the prior procedure. Your urologist can now report the patient's condition using the new ICD-9 code for chronic postoperative pain, 338.28.