Urology Coding Alert

Additional BMI codes help you get specific for E/M coding.

Every October 1, you're faced with new diagnosis codes, code deletions, and code revisions. This year, however, you'll have minimal changes to learn for your Urology Coding . Save yourself the hassle of scouring the full list, and focus on this rundown of the changes that may affect urology practices.Count on New Personal History of Congenital Correction Code The proposed changes to ICD-9 2011 add one new personal history code specific to genitourinary congenital corrections: V13.62 (Personal history of other [corrected] congenital malformations of genitourinary system). This code is among the most significant changes for urology coders because your urologist may need to indicate this history for some patients.

Example: Your urologist treats chronic prostatitis in an adult patient who had a hypospadias penile repair as a child. Adding to your claim V13.62 as well as using 601.1 (Chronic prostatitis) will add to the reporting accuracy of your overall clinical scenario.

Replace 787.6 With 5 New Fecal-Related Diagnoses

You may also occasionally use five new fecal impaction and incontinence codes in your urological practice. ICD-9 2011 deletes 787.6 (Incontinence of feces) and adds the following:

• 560.32 -- Fecal impaction
• 787.60 -- Full incontinence of feces
• 787.61 -- Incomplete defecation
• 787.62 -- Fecal smearing
• 787.63 -- Fecal urgency.

"Your urologist may use one of the above diagnoses for a complete ICD-9 clinical description in a patient with severe urinary incontinence as well as fecal impaction or fecal incontinence," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

Add Body Mass Index, BMI, V Codes to Your E/M Arsenal ICD-9 has "expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC with CRN Healthcare Solutions in Tinton Falls, N.J. Stop using V85.4 (Body Mass Index 40 and over, adult) on Oct. 1 and start using one of the following new V codes in its place:

• V85.41 -- Body Mass Index 40.0 " 44.9, adult
• V85.42 -- ... 45.0 " 49.9, adult
• V85.43 -- ... 50.0 " 59.9, adult
• V85.44 -- ... 60.0 " 69.9, adult
• V85.45 -- ... 70 and over, adult.

The benefit: "BMI has become an important health tool, and those codes [V85.41-V85.45] will also provide more data,"  says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCPP, CEO of Healthcare Consulting & Coding Education LLC.

"There are seven vital signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who are of the opinion that BMI should be an eighth option," Vogelberger says. If that eighth bullet gains traction and comes into play for coders, the new V codes could help considerably.

Resource: CMS posted the proposed codes as part of the Inpatient Proposed Payment System, available online at www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp. To review the codes, download "Proposed Tables 6A-6K." Table 6A includes proposed new codes, 6C shows the proposed deletions, and 6E lists proposed revisions.