The ICD-10 “go-live” day is less than two months away, and what that means to physicians’ practices will come into spotlight beginning Oct. 1. But one thing is sure, this transition might just streamline your work in some respects because ICD-10 is more straightforward and specific. However, there are things that specifically urologists should know before ICD-10 code set becomes the new norm.
- Comparing ICD-9 to ICD-10: Currently in ICD-9, when your urologist treats a ureteral stone, you apply code 592.1 (Calculus of ureter) to a specific procedure code (such as 52353, Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is covered]).However, in ICD-10 code 592.1 will expand into four options instead of relying on one code:
| N13.2 | Hydronephrosis with renal and ureteral calculus obstruction |
| N13.6 | Pyonephrosis, conditions in N13.0-N13.5 with infection |
| N20.1 | Calculus of ureter |
| N20.2 | Calculus of kidney with calculus of ureter |
- Specificity in Documentation
The reason behind the four new codes in ICD-10 is the fact that the patient may have other conditions along with uretral stone. So while documenting, keep in mind:
| When the patient has a ureteral stone only, you will report N20.1; |
| You’ll use code N13.2 for a ureteral stone with hydronephrosis; |
| You will use code N13.6 for a ureteral stone with hydronephrosis plus infection. |
| If the patient has both a ureteral and a kidney stone, you will turn to N20.2. |
- Pay Attention to Hernia Coding Changes in ICD-10
There are certain cases where the urologist teams up with general surgeons, such as a combined hernia and orchiopexy surgery. Although, the number of codes and diagnostic distinctions for coding inguinal hernias remains the same in ICD-10 like in ICD-9, however, elevating the bilateral/unilateral distinction from the fifth digit in ICD-9 to the fourth digit in ICD-10 bewilders the one-to-one code correspondence.
ICD-10 lists six, four digit codes for inguinal hernia:
| K40.0 | Bilateral inguinal hernia, with obstruction, without gangrene |
| K40.1 | with gangrene |
| K40.2 | without obstruction or gangrene |
| K40.3 | Unilateral inguinal hernia, with obstruction, without gangrene |
| K40.4 | with gangrene |
| K40.9 | without obstruction or gangrene. |
You should append a fifth digit to each of these codes to distinguish recurrent or not as follows:
| 0 | not specified as recurrent |
| 1 | recurrent. |
- Urinary Tract Infection Codes in ICD-10
A Urinary Tract Infection is a bacterial infection affecting any part of the urinary tract (kidneys, ureters, bladder, and urethra). When coding a UTI it is important to know what part of the urinary tract is affected by the infection because the location will determine what code you will assign.
| If the infection is affecting the: |
| Bladder (cystitis)- see Category 595 |
| Kidney (pyelonephritis)- see Category 590 |
| Unknown site (UTI NOS)- 599.0 |
Always remember to add a code for the organism causing the infection, if known.
UTI due to Urinary Catheter
If the cause of the UTI is due to a urinary catheter, assign code 996.64 followed by the appropriate UTI code.
ICD 10 codes:
Personal History of UTI: Z87.440
Urinary Tract Infection unspecified: N39.0
| ICD-9 | ICD-10 |
| 788.1 (Dysuria, painful urination) | R30.0 (Dysuria), R30.9 (Painful micturition, unspecified) |
| 788.41 (Urinary frequency) | R35.0 (Frequency of micturition) |
| 788.63 (Urgency of urination) | R39.15 (Urgency of urination) |
- New Combination Codes for Patient
In ICD-10 you will have new combination codes for patients with multiple problems, such as diabetes and renal failure. Unlike in ICD-9 where you had two or three codes for patient with renal failure and diabetes; ICD-10 will see only one combination code.
For an in-depth understanding on Urology coding in ICD-10, check out ProfEdOnDemand’s training conferences.
