Urology Coding Alert

Question: Our physicians perform ureteral stent exchanges in our ASC quite frequently. The ICD-10 diagnoses I assign areT19.1XXA, Z46.6, and a third one explaining the reason why the stent was originally needed. Hydrone­phrosis is the most common reason. My question is two-fold. First, does it matter what sequence the codes are in? Second, for those patients who have the stent permanently and return for an exchange every 6 months or so, should the seventh character of the diagnosis code be a "D"?

Wyoming Subscriber

Answer: You should not be using the T19.1xx- (Foreign body in bladder ...) codes for routine stent exchange encounters. Use just the Z46.6 (Encounter for fitting and adjustment of urinary device) as the first listed code and only if the condition of hydronephrosis is still present would you add it as a secondary. You should not treat a therapeutic device as a foreign body.