Wiki Coding Kidney stone, UTI, and hydronephrosis

[Tharville]

Can someone please give advice on coding these three diagnoses together, kidney stone, urinary tract infection, and hydronephrosis? We have an auditor saying these would be coded as pyonephrosis. But others are saying it should be kidney stone with hydronephrosis and the urinary tract infection coded separately. They believe the physician should say pyonephrosis to code this. In 3M, the option "with infection" is coded as the pyonephrosis diagnosis per the auditor. Can someone please give your opinion and a rationale if possible. Thank you in advance.

 

[jodielonkoski]

N13.6 hydronephrosis due to kidney stone is n13.2, which has an excludes 2 for n20 and an excludes 1 for n13.6. N13.6 says conditions in n13.0-n13.5 with infection. N39.0 for UTI has excludes 1 for n13.6. Based on these notes it is not clear to me why you would unbundle these codes. N13.6 is correct for these 3 conditions, the UTI is not coded separately. Further, in the index if you go to hydronephrosis; with infection > n13.6, or ;with obstruction renal or ureteral; with infection > n13.6

 

[sls314]

Can someone please give advice on coding these three diagnoses together, kidney stone, urinary tract infection, and hydronephrosis? We have an auditor saying these would be coded as pyonephrosis. But others are saying it should be kidney stone with hydronephrosis and the urinary tract infection coded separately. They believe the physician should say pyonephrosis to code this. In 3M, the option "with infection" is coded as the pyonephrosis diagnosis per the auditor. Can someone please give your opinion and a rationale if possible. Thank you in advance.

With a big caveat that I'm not looking at this specific patient's documentation and that I can't see exactly how it is documented...

There is a path in the alphabetic index for N13.6 without the physician specifically stating Pyonephrosis:





Do you have access to Coding Clinic? There's also Coding Clinic guidance from 2018, Volume 5, Number 2 that advises coding N13.6 for the below scenario:

A patient presents to the emergency department with hematuria, left-sided flank pain and chills. Computed tomography scan shows a left ureteral stone with hydronephrosis. The patient was admitted to the hospital for treatment and the final diagnosis is listed as acute urinary tract infection (UTI) and hydronephrosis with obstruction due to ureteral calculus. What is the correct ICD-10-CM code for this scenario?


While the Coding Clinic question specifically addresses a ureteral stone, it’s important to note that the Alphabetic Index leads to the same coding pathway for an obstructed renal calculus as well.

Again, I’m not reviewing the actual documentation for this specific patient, so I can’t offer an opinion on whether N13.6 is appropriate in this individual case.

However, I will say that, in general, the physician does not have to explicitly document “pyonephrosis” in order for N13.6 to apply. I’d encourage you to compare the Coding Clinic guidance and the Alphabetic Index references against the actual documentation and then reconsider whether it impacts your view of the auditor’s findings.

 

[Tharville]

N13.6 hydronephrosis due to kidney stone is n13.2, which has an excludes 2 for n20 and an excludes 1 for n13.6. N13.6 says conditions in n13.0-n13.5 with infection. N39.0 for UTI has excludes 1 for n13.6. Based on these notes it is not clear to me why you would unbundle these codes. N13.6 is correct for these 3 conditions, the UTI is not coded separately. Further, in the index if you go to hydronephrosis; with infection > n13.6, or ;with obstruction renal or ureteral; with infection > n13.6

Thank you so much! I appreciate your time.

 

[Tharville]

With a big caveat that I'm not looking at this specific patient's documentation and that I can't see exactly how it is documented...

There is a path in the alphabetic index for N13.6 without the physician specifically stating Pyonephrosis:


View attachment 9063


Do you have access to Coding Clinic? There's also Coding Clinic guidance from 2018, Volume 5, Number 2 that advises coding N13.6 for the below scenario:

A patient presents to the emergency department with hematuria, left-sided flank pain and chills. Computed tomography scan shows a left ureteral stone with hydronephrosis. The patient was admitted to the hospital for treatment and the final diagnosis is listed as acute urinary tract infection (UTI) and hydronephrosis with obstruction due to ureteral calculus. What is the correct ICD-10-CM code for this scenario?


While the Coding Clinic question specifically addresses a ureteral stone, it’s important to note that the Alphabetic Index leads to the same coding pathway for an obstructed renal calculus as well.

Again, I’m not reviewing the actual documentation for this specific patient, so I can’t offer an opinion on whether N13.6 is appropriate in this individual case.

However, I will say that, in general, the physician does not have to explicitly document “pyonephrosis” in order for N13.6 to apply. I’d encourage you to compare the Coding Clinic guidance and the Alphabetic Index references against the actual documentation and then reconsider whether it impacts your view of the auditor’s findings.

Awesome rationale! Thank you!