Urology Coding Alert

Question: Has there been a change to 041.4? We keep getting denials and I can't figure out why.

Florida Subscriber

Answer: There was a change to 041.4 on Oct. 1, 2011. The code now requires a fifth digit as follows:

• 041.41 -- Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157
• 041.42 -- Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC)
• 041.43 -- Unspecified Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified
• 041.49 -- Other and unspecified Escherichia coli [E. coli].

When your urologist reports that a patient has an infection, such as cystitis (595) you need to use an additional code to report the organism causing the infection. Often that organism is E. coli and you'll now report 041.41-041.49 rather than four-digit 041.4 to indicate the type of E. coli.

Background: Many E. coli bacteria are harmless, but certain strains can cause digestive problems ranging from diarrhea to hemorrhagic colitis. These strains are known as Shiga-toxin producing E. coli (STEC), and labs identify them by culture or other tests to detect the Shiga-toxin or the genes that produce the toxin. The most common STEC in the U.S. is E. coli O157:H7. If the lab isolates this strain in a culture, no further testing is needed to call the organism STEC. When the culture isolates non-O157 E. coli strains, or E. coli O157 with the H antigen not identified as H7, the lab will perform other tests before the organism can be identified as STEC.

Depending on the test results, you'll choose from the four new ICD-9 codes to report the findings, starting Oct. 1. According to Jeffrey Linzer Sr., MD, FAAP, FACEP, at the ICD-9-CM Coordination and Maintenance Committee Meeting (proposals, summaries, and presentation slides available at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm), many inclusion terms represented in the proposed new codes will be seen in the medical record, including microbiology laboratory results.