Internal Medicine Coding Alert

Question: Encounter notes state that the internist diagnosed hematuria in a patient. In the ICD-9 section for hematuria, there is more than one code. How can I figure out which one to choose?

Louisiana Subscriber

Answer: You'll either have to check the notes for evidence specifying hematuria type, or go ask the provider what type of hematuria he is treating. There are three hematuria codes. Check out this rundown on when to use each one:

• 599.70 (Hematuria, unspecified). Use this code if you cannot get any additional information on the patient's condition.

• 599.71 (Gross hematuria). If there is blood visible to the eye in the urine, it is gross hematuria. "The only visible sign of hematuria is pink, red, or cola-colored urine -- the result of the presence of red blood cells. It takes very little blood to produce red urine, and the bleeding usually isn't painful. Bloody urine often occurs without other signs or symptoms," according to the Mayo Clinic (http://www.mayoclinic.com/health/bloodin-urine/DS01013).

• 599.72 (Microscopic hematuria). This code represents "urinary blood that's visible only under a microscope, and is found when your doctor tests urine for another condition," according to the Mayo Clinic.

Best bet: Use this information against the encounter notes to see if you can figure out the proper diagnosis yourself -- and then double check with the provider. If you see evidence of other urinary tests on the claim, it could be microscopic hematuria. If the notes indicate that the urine was "pink," that might be your ticket to 599.71.