Urology Coding Alert

You'll be able to stop using unspecified fifth digits.

While the next edition of ICD-9 Codes doesn't bring an abundance of new urology-related codes for you to learn, you'll be grateful for the ones it does add. Come Oct. 1, 2011, you'll have more specific codes to use when a patient has complications with a cystostomy or vaginal mesh.

That's the news from recently posted proposed updates to the code set. If finalized, these codes will become effective Oct. 1, 2011. Here are the main proposals to watch in urology.

The big picture: "These proposed diagnoses are good," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. "They're going to be helpful."

Add 4 New 596 Codes

If you've been frustrated by having to use non-specific inflammation and complication codes,, when a patient has a problem with a cystostomy, ICD-9 2012 offers a better option.

Old way: "In general, coders have always had to use codes that were described as 'mechanical complications,' 'infection and inflammatory reaction,' or 'other complications,'" says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. "That's a catch all for any number of devices, implants or materials that are utilized by physicians."

New way: When the proposed diagnosis codes change on Oct. 1, you will have the following new codes:

• 596.81 -- Infection of cystostomy
• 596.82 -- Mechanical complication of cystostomy
• 596.83 -- Other complication of cystostomy.

How the codes work: You'll use 596.81 for a patient with an infection of the cystostomy stoma (opening), inflammation of the stoma with or without an abscess formation, or for a granuloma within the stoma, Ferragamo explains. "All of these scenarios represent inflammations or infections of the cystostomy for which now you have a new code. This is a descriptive code one may use for several clinical scenarios; an ICD-9 code we will be able to use now and avoid use of an unspecified inflammation code which we were compelled to use in the past."

Apply 596.82 when your urologist documents premature closure, stricture, or stenosis of the cutaneous cystostomy stoma. "These conditions represent mechanical complications of the cystostomy," Ferragamo says.

Use the new cystostomy code, 596.83, for complications such as persistent drainage, non-closure, prolapse of the mucosa, excoriation of the cystostomy site, bleeding, erosion, etc., Ferragamo says. "At times, after removal of a cystostomy tube, the siteremains open with prolonged persistent drainage," Ferragamo explains. "Use the latter ICD-9 code to describe this condition."

596.89 Offers a New Bladder Disorder Dx

ICD-9 2012 also adds 596.89 (Other specified disorders of bladder) to your diagnostic coding arsenal.

"I prefer not to use codes with the numeral 9 as the last digit. They usually signify other specific, but not listed, diagnoses, and many carriers will not accept them as payable diagnoses," Ferragamo warns. "I probably would not use this diagnostic code very often."

Capture Vaginal Mesh Complications With 2 New Codes

You'll find two new diagnoses related to implanted vaginal mesh in the ICD-9 2012 proposed codes:

• 629.31 -- Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue
• 629.32 -- Exposure of implanted vaginal mesh and other prosthetic materials into vagina,

"These codes are very clear and self-explanatory," Ferragamo says. "Erosion of a mesh is one of the main complications of a vaginal mesh placement or mesh used as a urethral sling," he adds.

"I particularly like the mesh codes," Hollingshead agrees. "We've had mesh into the bladder and eroded slings into the vagina this past year and I love that they're separate diagnosis codes now."

Good news: "These two latter codes would probably replace using the codes 996.76, which would be a complication of a genital urinary device, or in place of 996.65, which would be an inflammation or infection of a urinary device or prosthesis,"  Ferragamo explains. "These new codes are much more specific. They're excellent additions because they explain clearly the clinical problem you're treating. You're not using a code that could mean many things; these codes are very specific. And these are problems that do develop with the use of vaginal meshes and slings."

Note: There are no urology related revisions or deletions that you need to be concerned about.

Specificity matters: "I'm very pleased to see the addition of these new codes," Hollingshead says. "We'll now be able to be more specific as to the type of device, implant, or graft and the type of complication or infection. I think it's a good step forward in truly creating a much clearer picture for the insurance company and the practice. I think most coders will be very happy with these additions. I, for one, don't like catch-all, unspecified, or NOS codes. I like details. Specificity is key to me."

Looking forward: "It appears that the AMA is working toward ICD-10," says Becky Boone, CPC, CUC, coder with the University of Missouri Columbia. "These codes will make my job easier since these are diagnoses that we see regularly that get lumped into 99x.xx codes that are too general and do not allow for a better explanation of why the procedure is being done. I hope that they are doing more of this to get us ready for the changes to ICD-10."