Urology Coding Alert

“Paying attention to and understanding the meaning of … notes is extremely important for the medical coder, because they are integral to correct coding,” says Melanie Scott, CPC, CRHC, CPPM, CMPE, director of operations at Five Valleys Urology in Missoula, Montana. “Looking at a single diagnosis code is not enough when it comes to correct coding. You have to look at all the applicable codes to ensure that you are not violating ICD-10 conventions.”

Check New Codes for New Notes

Many of these changes relate to code changes. For example, new code N06.22 will have the following notes beneath it:

• Code first, if applicable, other disease or disorder or poisoning causing membranousnephropathy
• Use additional code, if applicable, for adverse effect of drug causing membranousnephropathy
• Excludes1: secondary membranous nephropathy with nephrotic syndrome (N04.22)

Get Specific With Note Revisions

Other note updates affect codes that themselves remain unchanged. For example, the Excludes1 note under parent code N20 (Calculus of kidney and ureter) will change from “nephrocalcinosis (E83.5)” to “nephrocalcinosis (E83.59).”

Missing these note updates can wreak havoc on your claims’ success. “Accuracy and compliance are important to the bottom line,” Scott says.

“Paying close attention to the notes will ensure proper coding and prevent claim denials and rework of those denials,” agrees Penny Walker, CPC, CHONC, CCC, provider coding specialist at the Marshfield Medical Center-Dickinson in Iron Mountain, MI. “Our goal is to code to the most specific diagnosis as possible and following these rules will ensure that.”

For example, if you code for a urogynecologist and you miss the change in the note under N81.6 (Rectocele), you may face denials. ICD-10-CM 2024 changes “rectocele with prolapse of uterus (N81.2-N81.4)” from an Excludes2 note to an Excludes1 note.

Remember: While they sound similar, Excludes1 and Excludes2 instructions are very different in practice for diagnosis coding.

According to the ICD-10-CM Official Guidelines, section I.A.12.a, Excludes1 is a “pure excludes note,” which means the listed code should never be used at the same time as the code listed above the Excludes1 instruction. Another way of interpreting the rule is that the two conditions cannot occur together.

On the other hand, according to the ICD-10-CM Official Guidelines, section I.A.12.b, an Excludes2 note represents “not included here.” This means that the condition is not a part of the condition represented by the initial diagnosis code, “but a patient may have both conditions at the same time.”

In short, Excludes1 means the two codes may never be used together, while Excludes2 allows two or more codes to be used together, when appropriate; so, changing the note for N81.6 changes the diagnosis codes you can report together.

Remember: “Following Excludes1 and Excludes2 notes will reduce claim denials as payers are starting to enforce their use by updating their policies and using claims processing software,” Scott says.