Wiki PHI Billing

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
Code: R31.1

Code Name: ICD-10 Code for Benign essential microscopic hematuria

Block: Symptoms and signs involving the genitourinary system (R30-R39)

Details: Benign essential microscopic hematuria
Excludes1: hematuria included with underlying conditions, such as:acute cystitis with hematuria (N30.01)
recurrent and persistent hematuria in glomerular diseases (N02.-)

Guidelines: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Note: This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
The conditions and signs or symptoms included in categories R00-R94 consist of:
(a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
(b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
(c) provisional diagnosis in a patient who failed to return for further investigation or care;
(d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
(e) cases in which a more precise diagnosis was not available for any other reason;
(f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.

Excludes 2: abnormal findings on antenatal screening of mother (O28.-)
certain conditions originating in the perinatal period (P04-P96)
signs and symptoms classified in the body system chapters
signs and symptoms of breast (N63, N64.5)

For more details on R31.1, ICD-10 Code for Benign essential microscopic hematuria, visit:


Best answers
Does anyone have any information on billing a Prostate Health Index (PHI) 84153, 84154 and 86316. We are billing all three codes with diagnosis R97.20. Medicare pays the 84153 and 84154 but not the 86316. They are denying it as not medically necessary. Can the 86316 only be billed with bladder/urinary symptoms??


True Blue
Best answers
Its not covered for those that are asymptomatic. H[FONT=&quot]ematuria & neoplasms, everything else not covered by medicare

I only found one active LCD from Palmetto - L33420[FONT=&quot]
[h=4]ICD-10-CM Codes that support Medical Necessity:[/h][FONT=&quot]C67.0 - Malignant neoplasm of trigone of bladder
C67.1 - Malignant neoplasm of dome of bladder
C67.2 - Malignant neoplasm of lateral wall of bladder
C67.3 - Malignant neoplasm of anterior wall of bladder
C67.4 - Malignant neoplasm of posterior wall of bladder
C67.5 - Malignant neoplasm of bladder neck
C67.6 - Malignant neoplasm of ureteric orifice
C67.7 - Malignant neoplasm of urachus
C67.8 - Malignant neoplasm of overlapping sites of bladder
C67.9 - Malignant neoplasm of bladder, unspecified
C7A.00 - Malignant carcinoid tumor of unspecified site
C7A.098 - Malignant carcinoid tumors of other sites
C7A.8 - Other malignant neuroendocrine tumors
C7B.00 - Secondary carcinoid tumors, unspecified site
C7B.09 - Secondary carcinoid tumors of other sites
C7B.8 - Other secondary neuroendocrine tumors
C78.00 - Secondary malignant neoplasm of unspecified lung
D09.0 - Carcinoma in situ of bladder
D41.4 - Neoplasm of uncertain behavior of bladder
D49.4 - Neoplasm of unspecified behavior of bladder
R31.0 - Gross hematuria
R31.1 - Benign essential microscopic hematuria
R31.21 - Asymptomatic microscopic hematuria
R31.29 - Other microscopic hematuria
R31.9 - Hematuria, unspecified
Z78.9* - Other specified health status
Z85.51* - Personal history of malignant neoplasm of bladder

R31.2 (before October 1, 2016) and R31.21 or R31.29 (effective October 1, 2016) are to be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.

Z78.9 To be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.

Z85.51 To be used only when repeat testing is believed to be medically reasonable and necessary, and must be listed as secondary with the primary neoplastic diagnosis.