Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 24, 2006 PDF

Specificity increases your chances of reimbursement for some E/M services

You’ll soon have two new urinary symptom codes to use thanks to the ICD-9 update that takes effect on Oct. 1, 2006. Here’s how the changes will affect your practice’s claims.

New options: Urology coders will benefit from the addition of 788.64 (Urinary hesitancy) and 788.65 (Straining on urination), two conditions that were previously not listed, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio. Up until now, you’ve been forced to report these symptoms with 788.9 (Other symptoms involving urinary system), but starting in October you’ll have more specific options.

Example: Patients frequently complain of urinary hesitancy and straining on urination when they have an outflow obstruction due to bladder neck contraction, says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook.

For the outflow obstruction condition, you’ll report 596.0 (Bladder neck obstruction) along with 600.01 (Prostatic hyperplasia) and 598.9 (Urethral stricture, unspecified). Now you can also prove medical necessity for E/M services your urologist provides based on these two new diagnosis codes representing urinary hesitancy and straining on urination.