Urology Coding Alert

Start preparing now for October 1 code changes.

‘Tis the season! ICD-10-CM annual updates are right around the corner, and while there are fewer new urology diagnosis codes for implementation on Oct. 1, 2023 than there were last year, urology is not spared updates. Now’s the time to get to know the changes that are coming so you’re prepared to start accurately reporting the codes this fall.

The good news is that the Urology Coding Alert experts have scoured the 501 new and 26 revised codes for you. Read on to focus on the urology-specific news you need to know.

Update Your Urethral Stricture Descriptor

ICD-10-CM 2024 revises urethral stricture code N35.812 from (Other urethral bulbous stricture, male) to (Other bulbous urethral stricture, male).

“The change is the order of the descriptor from other urethral bulbous stricture, male to other bulbous urethral stricture, male,” explains Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coder and consultant in Glen Burnie, Maryland. “Although the change is minor and will not impact appropriate diagnosis coding, urologists refer to this type of stricture as a bulbous urethral stricture and not a urethral bulbous stricture. Bulbous describes the type of urethral stricture. This change matches current urological terminology. The term ‘bulbous’ describes a type of urethral stricture. A bulbous stricture refers to a bulb-shaped narrowing of the urethra connected to the bladder that reduces the flow of urine and makes it more painful and difficult to pass urine. Strictures of this type can also be referred to as ‘bulbar’ strictures.”

Note: Of the 26 revised codes, only 17 were revisions to the long code descriptors to which coders refer, and only this one applies in urology.

Prepare for Nephrology Code Makeover

If your urologist works with a nephrologist, you’ll have several new codes and a few revised codes to consider in October. You’ll find the following new codes in ICD-10-CM 2024:

• Parent code (unreportable without additional characters): N02.B Recurrent and persistent immunoglobulin A nephropathy
  • Child codes:
    • N02.B1 (Recurrent and persistent immunoglobulin A nephropathy with glomerular lesion)
    • N02.B2 (… with focal and segmental glomerular lesion)
    • N02.B3 (… with diffuse membranoproliferative glomerulonephritis)
    • N02.B4 (… with diffuse membranous glomerulonephritis)
    • N02.B5 (… with diffuse mesangial proliferative glomerulonephritis)
    • N02.B6 (… with diffuse mesangiocapillary glomerulonephritis)
    • N02.B9 (Other recurrent and persistent immunoglobulin A nephropathy)

“IgA nephropathy, also known as Berger’s disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues,” Storck explains. “IgA is an antibody — a protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease. The laboratory testing to determine IgA is probably very specific. It is an autoimmune kidney disease.”

ICD-10-CM 2024 continues its expansion of nephrology-related diagnoses by converting N04.2 (Nephrotic syndrome with diffuse membranous glomerulonephritis) and N06.2 (Isolated proteinuria with diffuse membranous glomerulonephritis) to parent codes and adding the following new codes beneath them, respectively:

• N04.20 (Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified)
• N04.21 (Primary membranous nephropathy with nephrotic syndrome)
• N04.22 (Secondary membranous nephropathy with nephrotic syndrome)
• N04.29 (Other nephrotic syndrome with diffuse membranous glomerulonephritis)
• N06.20 (Isolated proteinuria with diffuse membranous glomerulonephritis, unspecified)
• N06.21 (Primary membranous nephropathy with isolated proteinuria)
• N06.22 (Secondary membranous nephropathy with isolated proteinuria)
• N06.29 (Other isolated proteinuria with diffuse membranous glomerulonephritis)

Capture Full Diagnostic Picture With W and Z Codes

You’ll find 173 of the new ICD-10-CM 2024 under W44 (Foreign body entering into or through a natural orifice). Your urologist may need these new codes if a patient has a foreign body in their urethra, for example. The codes are broken down by the type of foreign body, as follows:

• W44.8- (Other foreign body entering into or through a natural orifice)
• W44.9- (Unspecified foreign body entering into or through a natural orifice)
• W44.A- (Battery entering into or through a natural orifice)
  • W44.A0- (Battery unspecified …)
  • W44.A1- (Button battery …)
  • W44.A9- (Other batteries …)
• W44.B-(Plastic entering into or through a natural orifice)
  • ​W44.B0- (Plastic object unspecified …)
  • W44.B1- (Plastic bead …)
  • W44.B2- (Plastic coin …)
  • W44.B3- (Plastic toy and toy part …)
  • W44.B4- (Plastic jewelry …)
  • W44.B5- (Plastic bottle …)
  • W44.B9- (Other plastic object …)
• W44.C-(Glass entering into or through a natural orifice)
  • W44.C0- (Glass unspecified …)
  • W44.C1- (Sharp glass …)
  • W44.C2- (Intact glass …)
• W44.D- (Magnetic metal entering into or through a natural orifice)
  • ​W44.D0- (Magnetic metal object unspecified …)
  • W44.D1- (Magnetic metal bead …)
  • W44.D2- (Magnetic metal coin …)
  • W44.D3- (Magnetic metal toy …)
  • W44.D4- (Magnetic metal jewelry …)
  • W44.D9- (Other magnetic metal objects …)
• W44.E- (Non-magnetic metal entering into or through a natural orifice)
  • ​W44.E0- (Non-magnetic metal object unspecified …)
  • W44.E1- (Non-magnetic metal bead …)
  • W44.E2- (Non-magnetic metal coin …)
  • W44.E3- (Non-magnetic metal toy …)
  • W44.E4- (Non-magnetic metal jewelry …)
  • W44.E9- (Other non-magnetic metal objects …)
• W44.F- (Objects of natural or organic material entering into or through a natural orifice)
  • W44.F0- (Objects of natural or organic material unspecified …)
  • W44.F1- (Bezoar …)
  • W44.F2- (Rubber band …)
  • W44.F3- (Food …)
  • W44.F4- (Insect …)
  • W44.F9- (Other object of natural or organic material …)
• W44.G- (Other non-organic objects entering into or through a natural orifice)
  • W44.G0- (Other non-organic objects unspecified …)
  • W44.G1- (Audio device …)
  • W44.G2- (Combination metal and plastic toy and toy part …)
  • W44.G3- (Combination metal and plastic jewelry …)
  • W44.G9- (Other non-organic objects …)
• W44.H- (Other sharp object entering into or through a natural orifice)
  • W44.H0- (Other sharp object unspecified …)
  • W44.H1- (Needle …)
  • W44.H2- (Knife, sword or dagger …)

Each of these codes requires a 7^th character representing the encounter type as follows:

• A: initial encounter
• D: subsequent encounter
• S: sequela

SDoH: You’ll also find several new social determinants of health (SDoH) codes added in ICD-10-CM 2024, including these that you may use in urology:

• Z29.89 (Encounter for other specified prophylactic measures)
• Z62.23 (Child in custody of non-parental relative)
• Z62.24 (Child in custody of non-relative guardian)
• Z62.823 (Parent-step child conflict)
• Z62.83 (Non-parental relative or guardian-child conflict)
• Z62.831 (Non-parental relative-child conflict)
• Z62.832 (Non-relative guardian-child conflict)
• Z62.833 (Group home staff-child conflict)
• Z62.892 (Runaway [from current living environment])
• Z91.A41 (Caregiver’s other noncompliance with patient’s medication regimen due to financial hardship)
• Z91.A48 (… for other reason)
• Z91.A51 (Caregiver’s noncompliance with patient’s renal dialysis due to financial hardship)
• Z91.A58 (… for other reason)
• Z91.A91 (Caregiver’s noncompliance with patient’s other medical treatment and regimen due to financial hardship)
• Z91.A98 (… for other reason)

Clinicians should be documenting SDoH and, in general, you should be coding them. Presently, “more attention is being drawn to patients’ social determinants of health,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. By accurately documenting SDoH, healthcare providers can better understand the factors affecting a patient’s health, leading to improved care management, resource allocation, and health outcomes.

Learn more: To review when and how you should report SDoH codes, go back to Urology Coding Alert, Vol. 24, No. 12 and read “Unlock SDoH Coding Success With These 6 FAQs.”