Urology Coding Alert

Starting Oct. 1, you'll have more diagnoses that will justify these tests Effective Oct. 1, you can start using additional diagnosis codes to support urine cultures and prostate specific antigen tests, a new transmittal from CMS said (Transmittal 1050).

These changes are taking place as part of several changes that "will be included in the October 2006 release of the edit module for clinical diagnostic laboratory services," the transmittal says. Be sure to update your staff and your software system with the following changes:

• Urine culture, bacterial: CMS is adding the following codes as approved diagnoses for this test: 288.00, 288.01, 288.02, 288.03, 288.04, 288.09, 608.20, 608.21, 608.22, 608.23, 608.24, 616.81, 616.89, 780.96, 780.97, 788.64 and 788.65.

• Urine culture, bacterial: CMS is deleting the following codes as approved diagnoses for this test: 288.0, 608.2 and 616.8.

• Prostate specific antigen (PSA): CMS is adding the following codes as approved diagnoses for this test: 600.00, 600.10, 600.11, 600.21, 788.64 and 788.65. What it means to you: The addition of the new ICD-9 Codes 788.64 (Urinary hesitancy) and ICD-9 788.65 (Straining on urination) to both the urine culture and diagnostic PSA National Coverage Determinations is a welcome change, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.

"But the most exciting addition of course is BPH without obstruction (600.00) and prostate nodule (600.10 and 600.11) to the NCD for diagnostic PSA," Hause says. "Often, patients with these conditions presented with symptoms attributable to these definitive diagnoses, and we would be in conflict with coding guidelines because their symptoms were covered, but the underlying cause was not. Also, this will greatly help the administrative burden of ABN use for patients."

Note: See the article "Welcome These New Urinary Symptom Diagnosis Codes Debuting in October" in the June 2006 issue of Urology Coding Alert for more on the new 2007 ICD-9 codes.