Urology Coding Alert

CMS gets specific with male genital disease diagnoses

Urology coders will finally be able to specify whether urinary obstruction is associated with patients' prostate conditions thanks to new ICD-9 Codes that take effect Oct. 1. CMS unveiled the new diagnosis codes, several of which affect urology practices, in the May 19 Federal Register.

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.

Out With the Old, in With the New

Beginning Oct. 1, you will need to report a five-digit diagnosis code for patients who present with prostate hypertrophy to indicate to the payer whether the patient has associated urinary obstruction. Codes 600.00 (Hypertrophy [benign] of prostate without urinary obstruction) and 600.01 (Hypertrophy [benign] of prostate with urinary obstruction) replace 600.0 (Hypertrophy [benign] of prostate), which will be deleted when the new codes take effect.

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 [...]