Urology Coding Alert
Reporting 2 ICD-9 Codes for BPH and Urinary Obstruction? Not for Long
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CMS' new diagnosis codes have something in common: fifth digits. CMS has introduced several urology-related diagnosis codes that will make your signs and symptoms coding more accurate and more specific.
CMS is also replacing the code for current nodular prostate (600.1, Nodular prostate), the code for benign localized hyperplasia of the prostate (600.2, Benign localized hyperplasia of prostate), and the code for unspecified hyperplasia of the prostate 600.9 (Hyperplasia of prostate, unspecified) with five-digit codes that indicate whether the patient also has urinary obstruction.
Codes 600.10 (Nodular prostate without urinary obstruction) and 600.11 (Nodular prostate with urinary obstruction) will replace 600.1. CMS replaced 600.2 with 600.20 (Benign localized hyperplasia of prostate without urinary obstruction) and 600.21 (Benign localized hyperplasia of prostate with urinary obstruction). Codes 600.90 (Hyperplasia of prostate, unspecified, without urinary obstruction) and 600.91 (Hyperplasia of prostate, unspecified, with urinary obstruction) will replace 600.9.
Until the changes take effect, coders will continue to use the 600.x codes and will simply include an additional code(s) to represent any associated urinary obstruction, says Connie Copeland, coder and HIPAA compliance officer for urology Professionals Association in Tupelo, Miss. Copeland says her practice now reports the appropriate four-digit 600.x code as well as 599.6 (Urinary obstruction, unspecified) or 596.0 (Bladder neck obstruction), or 788.20 (Urinary retention) if the patient presents with prostate disease and urinary obstruction.
Copeland hypothesizes that the new fifth digits have been added to increase specificity and facilitate supporting medical necessity possibly linked to the implementation of the new HIPAA privacy laws.
I use 788.29 and 600.0 to code for retention due to benign prostatic hypertrophy "" says Alice Kater CPC coding specialist with Urology Associates of South Bend Ind. Urinary obstruction is common with prostate disease because the prostate is positioned directly below the urinary bladder and surrounds the beginning of the urethra so with any prostatic enlargement (hypertrophy) obstructive uropathy could and does occur she says. Her rationale for the fifth digits: The more exact the code the less chance for subjective interpretation.
Both Copeland and Kater eagerly await notice from their carriers as to whether they will add the new 600 series codes to their national local medical review policies for diagnostic prostate specific antigen (PSA) tests.
Now if a patient presents with a fractured penis the most accurate code is ""959.1 (Trunk injury injury to the external genitals) because there was not a diagnosis code specific to a fractured penis "" says Kathryn Sullivan CPC coding specialist with Harvard Vanguard Medical Associates in Massachusetts. But soon you will have the option of using 959.13 instead. Effective Oct. 1 959.1 will be an invalid code without a fifth digit.
In other changes CMS is expanding 752.8 (Other specified anomalies of genital organs) and adding a new scrotal transposition code 752.81 (Scrotal transposition) and is also adding a fifth digit to the code for the ""Other specified anomalies of genital organs "" 752.89. In other pertinent additions CMS is adding a third five-digit code to the 788.6 series: 788.63 (Urgency of urination). CMS also added a code for Peyronie's disease (607.85 Peyronie's disease) and a code for septic shock (785.52 Septic shock).
""The new code that jumps out at me is the urinary urgency code 788.63 "" Kater says. ""I love it."" Now she uses 788.69 (Other abnormality of urination other) to represent urinary urgency. ""As a coder I love specificity so 788.63 is one I know I'll use frequently "" she adds.
In the past Michael A. Ferragamo MD FACS clinical assistant professor of urology at the State University of New York Stony Brook has recommended that coders use ICD-9 code 607.89 (Other specified disorders of penis; other) for Peyronie's disease of the penis and 785.59 for septic shock. But this won't be true for long after these new codes take effect he says.
Until Oct. 1 coders will want to continue to use 752.8 for scrotal transposition 788.69 for urinary urgency 607.89 for Peyronie's disease and 785.59 for septic shock.
Use New V Code for Converted Surgeries
For a complete list of the new and invalid diagnosis codes see ""Quick Key: Incorporate These Urology-Related ICD-9 Changes .""
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