ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of severe stomach pain and trouble urinating; he says it's been "almost two days" since he could urinate without "9 out of 10" pain. The ED physician orders a urinalysis, finds blood in the urine, and refers the patient to a urologist for further care. What ICD-9 codes should I use to report this scenario?

South Carolina Subscriber

Answer: The physician diagnosed the patient with hematuria, but you'll have to do some more digging to arrive at the most accurate diagnosis code. On the claim, report the appropriate-level ED E/M code based on the encounter notes (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: ...).

Dx coding: Double-check with the physician or check the notes to see if the blood was visible to the naked eye, or if the physician needed visualization to spot the blood. Based on that information, choose one of the following diagnoses:

• 599.70 (Hematuria, unspecified) if you cannot get any more information on the nature of the hematuria
• 599.71 (Gross hematuria) if the blood was visible without a microscope
• 599.72 (Microscopic hematuria) if the blood was only visible with a microscope.