Pediatric Coding Alert

And see which UTI code is specific to neonates.

Coding for urinary tract infections (UTIs) seems straight-forward. After all, a quick index search turns up N39.0 (Urinary tract infection, site not specified), which seems easy enough. However, when you look a little deeper, you’ll see additional UTI codes related to infection location and other conditions.

Like all diagnoses, the key to correct UTI coding is detailed documentation. Here are a few things to look for in the medical record that will help direct you to the right codes.

Look for Location

If the pediatrician makes a definitive UTI diagnosis, they should then also specify the site of the infection. For example, UTIs occurring in the kidneys, bladder, or urethra are all called different things:

• UTIs originating in the kidneys are diagnosed as pyelonephritis and are coded to N10 (Acute pyelonephritis).
• UTIs originating in the bladder are diagnosed as cystitis and are coded to N30.- (Cystitis).
• UTIs originating in the urethra are diagnosed as Urethritis and are coded to N34.- (Urethritis and urethral syndrome).

Use N39.0 sparingly: N39.0 is still a valid code for a UTI, but the lack of site specificity often causes reimbursement hassles. “Diagnosing a UTI without a culture is becoming a thing of the past,” says Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics LLP in Northampton, Massachusetts. Therefore, payers are increasingly less likely to accept unspecified UTI codes.

If there isn’t enough information to report a more specific code, it’s generally best to stick to signs and symptoms while the provider gathers enough details to make a site-specific diagnosis. Look for keywords in the documentation such as “abdominal pain,” “incontinence,” “urine retention,” “pus in the urine (pyuria),” or “excessive urination (polyuria).” Depending on which symptoms the provider documents, you might code the following:

• R30.- (Pain associated with micturition)
• R32 (Unspecified urinary incontinence)
• R33.- (Retention of urine)
• R35.- (Polyuria)
• R39.1- (Other difficulties with micturition)
• R82.81 (Pyuria)

Look for Acute or Chronic Presentation

Whether the patient is suffering an acute infection or a chronic one will also affect which codes you select, so this is an important detail to look out for in the medical record. For example, if the pediatrician diagnosed cystitis, which you know from above is a UTI originating in the bladder, your provider’s note should outline whether the diagnosis is specific to acute (sudden) or chronic (persistent) cystitis. If your physician documents the patient with acute cystitis, you’ll report N30.0- (Acute cystitis), but if the documentation states chronic cystitis, you’ll report N30.1- (Interstitial cystitis (chronic)) or N30.2- (Other chronic cystitis).

Remember: As a coder, you are not to assume a condition is acute or chronic. ICD-10-CM does not define the terms “acute” or “chronic” and there are no standardized timeframes associated with them. Section I.A.15 of the ICD-10-CM guidelines therefore states that the provider needs to make this distinction.

For example, let’s say that it’s obvious from the medical record that a patient has had several UTIs that the pediatrician indicated as cystitis. According to the provider’s notes, the patient has a recurrent infection. She had a full round of Cipro and nitrofurantoin at home for self-treatment. If she has another UTI, she will take Cipro again. If that doesn’t work, she’ll take the nitrofurantoin. The provider said the infection was recurrent, not chronic, which means you still report N30.0-, rather than N30.1- or N30.2-.

Also: Do not report Z87.440 (Personal history of urinary (tract) infections) based simply on the term “recurrent” unless your provider has also documented a history of UTIs in the past.

Look for the Infectious Agent

All these UTI codes also come with “Use additional code” instructions that tell you to use a code from the B95-B97 (Bacterial and viral infectious agents) if a test ordered by your provider shows that a bacterium or virus is the cause of the condition. So, you should keep these additional common bacterium or virus codes handy:

• B96.2- (Escherichia coli [E. coli] as the cause of diseases classified elsewhere)
• B96.1 (Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere)
• B96.4 (Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere)
• B95.2 (Enterococcus as the cause of diseases classified elsewhere)
• B95.7 (Other staphylococcus as the cause of diseases classified elsewhere)

Look for Words Like “Neonate,” “Stoma,” and Pregnancy”

Coding for UTIs in neonates, patients with a stoma (an opening in the body to remove bodily waste following surgery), and patients who are or have recently been pregnant is a little different.

UTIs in neonates: If the patient is under 28 days of age and has a UTI, use P39.3 (Neonatal urinary tract infection)

UTIs in patients with stomas: You’ll code a patient who has a stoma with N99.521 (Infection of incontinent external stoma of urinary tract) or N99.531 (Infection of continent stoma of urinary tract). But before using one of these codes, you will need to make sure that your provider has documented and confirmed a cause-and-effect relationship between the procedure and the condition.

UTIs during and after pregnancy: “Organisms causing UTI in pregnancy are the same uropathogens which commonly cause UTI in non-pregnant patients” (www.ncbi.nlm.nih.gov/books/NBK537047/). But your coding for pregnant patients will be a little different.

Most often, you’ll use a code from the O23.- (Infections of genitourinary tract in pregnancy) group, which contains a “Use additional code” instruction for bacterial etiology coded to B95.- or B96.-. But you’ll use a code from O86.2- (Urinary tract infection following delivery) for patients diagnosed with a UTI after giving birth. And you’ll also find pregnancy-related UTI codes among the Pregnancy with abortive outcome (O00-O08) codes should your provider document the condition. For example, you may report O03.38 in the case of a UTI following incomplete spontaneous abortion.