Urology Coding Alert

The one-year implementation delay doesn’t mean you should rest on your laurels. 

Despite the fact that you’ll have another year before you have to start using the ICD-10 codeset, experts urge you to continue preparing for the change. (Read more about the delay in ICD-10 in the article “Congress Votes to Halt Your Pay Cuts and Delay ICD-10” on page 34.)

“For those that have prepared already the impact is possibly losing some of newly acquired ICD-10 coding skills for lack of use,” warns Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI, senior instructor at CodingCertification.org in Oceanville, N.J. “I recommend keeping up their skills by practicing ICD-10 coding a little each week. Brushing up on anatomy and practicing ICD-10 coding will make the transition much smoother and with less of a loss of productivity that has been projected.”

So continue your preparations by checking your answers to last month’s “Test Your ICD-10 Know-How With These 10 Questions” quiz. Based on your success, focus your attention over the next few months on your weakest areas.

Answer 1: Urethral Strictures

The ICD-10 code for a post-traumatic anterior urethral stricture in a female patient will be N35.013. To report a traumatic urethral stricture under ICD-9 you use 598.1 (Traumatic urethral stricture, stricture of urethra). In ICD-10-CM, there are several codes for a traumatic urethral stricture, including codes for both male and female identified by specific anatomic sites, as follows:

• N35.010 (Post-traumatic urethral stricture, male, meatal)
• N35.011 (Post-traumatic bulbous urethral stricture)
• N35.012 (Post-traumatic membranous urethral stricture)
• N35.013 (Post-traumatic anterior urethral stricture)
• N35.014 (Post-traumatic urethral stricture, male, unspecified)
• N35.021 (Urethral stricture due to childbirth)
• N35.028 (Other post-traumatic urethral stricture, female).

Answer 2: Acute Cystitis

The ICD-10 code for acute cystitis without mention of hematuria is N30.00. Rather than one code (595.0) for acute cystitis under ICD-9, you will have two codes under ICD-10: 

• N30.00 — Acute cystitis without hematuria
• N30.01 — Acute cystitis with hematuria. 

Answer 3: Post-Procedural Hemorrhage

The correct ICD-10 code to use when your urologist documents that following a circumcision, the patient had bleeding (hemorrhage) problems, which prompted a circumcision revision, is N99.820. 

When your urologist notes in his documentation that he performed a procedure, such as a circumcision revision, because the patient had bleeding (hemorrhage) problems, you typically report ICD-9 998.11 (Hemorrhage complicating a procedure). Code 998.11 expands into more than 55 new codes with ICD-10. The new codes indicate whether the hemorrhage occurred during the operative session with the descriptors noting “Intraoperative hemorrhage and hematoma of ...” or after the procedure, with the wording “Postprocedural hemorrhage and hematoma of ...” and specify the location of the hemorrhage. For this case, you should report N99.820 (Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure).

Answer 4: Polyuria

When your urologist documents an adult patient is suffering from an excessive or “abnormally large production of urine (over 2.5 to 3 liters per 24 hours), you’ll report R35.8 under ICD-10. This condition is known as polyuria. Currently, you are reporting this condition with 788.42 (Polyuria). As of October 1, 2015, you should report R35.8 (Other polyuria) instead.

Answer 5: Nocturia

For a patient who frequently wakes up at night to urinate, report ICD-10 code R35.1. This condition is called nocturia and you currently use ICD-9 code 788.43 (Nocturia). You would report that condition with R35.1 (Nocturia) as of Oct. 1, 2015.

Answer 6: Ectopic Testis

If your urologist performs an orchiopexy on a patient with a documented unilateral ectopic testis, you’ll use ICD-10 code Q53.01. 

When your urologist performs an orchiopexy procedure, you’ll most likely use one of the following ICD-9 codes along with the procedure code: 

• 752.51 — Undescended testis (includes ectopic testicle)
• 752.52 — Retractile testis. 

When ICD-10 takes effect in 2015, you will still have just one code for retractile testis: Q55.22 (Retractile testis). You will have multiple codes to replace 752.51, however. You will need to scour your urologist’s documentation to get the details to choose from the following new codes: 

• Q53.00 — Ectopic testis, unspecified 
• Q53.01 — Ectopic testis, unilateral 
• Q53.02 — Ectopic testes, bilateral 
• Q53.10 — Unspecified undescended testicle, unilateral 
• Q53.11 — Abdominal testis, unilateral 
• Q53.12 — Ectopic perineal testis, unilateral 
• Q53.20 — Undescended testicle, unspecified, bilateral 
• Q53.21 — Abdominal testis, bilateral 
• Q53.22 — Ectopic perineal testis, bilateral 
• Q53.9 — Undescended testicle, unspecified. 

Answer 7: Dysuria

Under ICD-10 report R30.0 (Dysuria) when you urologist documents “strangury.” While not completely synonymous, the term dysuria can also be documented as “strangury,” a term that refers to difficulty in micturition, with straining to void; urine may be passed intermittently with pain and spasms. Either of these terms would be reported as R30.0. You currently report this condition with ICD-9 788.1 (Dysuria).

Answer 8: Hydronephrosis

Your urologist documents the he placed stents during a procedure because the patient has intermittent hydronephrosis. Report N13.30 (Unspecified hydronephrosis). 

With ICD-9, when your urologist documents that a patient has hydronephrosis, you report 591 (Hydronephrosis) — which may include any or all of the following clinical scenarios: early hydronephrosis, hydronephrosis with an atrophic kidney, a functionless and infected kidney, intermittent hydronephrosis, or a primary or secondary type of hydronephrosis. 

When ICD-9 becomes ICD-10 in 2015, you’ll still have one diagnosis code for atrophic, early, functionless, intermittent, primary, and secondary not elsewhere classified (NEC) hydronephrosis: N13.30 (Unspecified hydronephrosis). For other specified types of hydronephrosis NEC, you’ll use N13.39 (Other hydronephrosis).

Answer 9: Renal Tumors

Report C65.1 (Malignant neoplasm of right renal pelvis) for a cancerous tumor in the right renal pelvis. 

When your urologist diagnoses that a patient has a renal tumor you have two codes to choose from under ICD-9:

• 189.0 — Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis
• 189.1 — Malignant neoplasm of renal pelvis.

Starting on Oct. 1, 2015, you will have six codes to choose from for renal tumors. Under ICD-10, you will first have to determine if the tumor is in the patient’s renal pelvis or the kidney. The ICD-10 diagnosis code for a kidney (renal) tumor will be C64, and the code for a renal pelvic tumor will be C65. However, with ICD-10 you can’t stop there. C64 and C65 both require a fourth digit. To determine that fourth digit, you will need to scour your urologist’s documentation for information about whether the tumor is in the right or left kidney or renal pelvis. For the fourth digit, add a 1 for a right sided tumor, a 2 for a left sided tumor, and a 9 for tumor, unspecified side.

Answer 10: Urosepsis

There is no ICD-10 code for urosepsis. In ICD-9, you have coding conventions to follow, which is to use 599.0 (Urinary tract infection, site not specified) for “urosepsis.” ICD-10 eliminates this term. The ICD-10-Manual includes a note to “code to condition,” which means you must query the physician to determine the appropriate code assignment.

Specifically, ICD-10 guidelines state:

(ii) Urosepsis The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.