Revenue Cycle Management in the Age of ICD-10: A Primer for Urology

UrologyContinuing our series on ICD-10-CM basics we are offering high-level primers to illustrate the differences on specific documentation requirements for various specialties. We will also give some samples of how ICD-9-CM codes common for those specialties compare to ICD-10-CM codes. Again, much of the material in these speciality-specific blog posts is based on guidelines and material published by CMS in its Road to 10 Series. There is a lot of questionable information and advice out there and we want to help improve the consistency and reduce the uncertainty by going to the source of regulations. We will summarize and consolidate to enhance readability and brevity. The application of ICD-10 documentation requirements and the common codes for Urology is the focus of this post. In ICD-10-CM, there are three main categories of changes:

  • Definition Changes
  • Terminology differences
  • Increased specificity

In Urology coding, the main areas in which laterality (left versus right) needs to be documented for correct code choice are benign and malignant genital and urinary neoplasms (kidney, renal pelvis, ureter, and testicle) and renal trauma (contusion and laceration). There are almost no other urology codes that contain laterality. To highlight this example, consider C64, malignant neoplasm of the kidney, except renal pelvis.  C64 itself is not a billable code as this condition is further subclassified into three more specific (billable) codes: C64.1, malignant neoplasm of the right kidney, except renal pelvis; C64.2, malignant neoplasm of the left kidney, except renal pelvis; and C64.9, malignant neoplasm of unspecified kidney, except renal pelvis. There are no codes describing the location within the kidney, the size of the tumor, the type of tumor, severity, or underlying condition. If one knows the side of the tumor, then the specific code should be used; it is not proper to choose the “unspecified” if laterality is known. Because there is no “bilateral” code, if a patient has malignant neoplasms of both the right and left kidney, both ICD-10 codes should be chosen. In terms of location, conditions such as penile cancer, urethral stricture, undescended testicle, and hypospadias require information about the location of the condition for the most accurate code choice. When multiple visits are required, a “seventh character” is necessary for correct coding. Specifically for urology, this seventh character is to document trauma and complications. From a documentation standpoint, these conditions require documentation of whether this is the initial visit for the condition/trauma, a subsequent visit, or a visit to help manage the sequelae of the condition. For those who are submitting the codes, a seventh character is used, wherein the character “A” represents the correct seventh character for the initial visit, “D” for a subsequent visit, and “S” indicates a visit for the sequelae of the condition. This letter must always be in the seventh position; a placeholder “X” (or multiple placeholder “X”s) may be used between the code and the seventh character to ensure that the letter is always in the seventh position. For example, puncture wound of the penis with foreign body will be found at S31.24; it is the initial encounter for this condition, the correct code will be S31.24XA, with the “A” in the seventh position and an “X” as a placeholder at the sixth position. A subsequent visit for this condition will be correctly coded as S31.24XD. Although many chapters contain codes that may pertain to Urology, the primary chapter covering this specialty is Chapter XIV: Diseases of the genitourinary system. This chapter is further divided as follows:

  • N00–N08 Glomerular diseases
  • N10–N16 Renal tubulo-interstitial diseases
  • N17–N19 Renal failure
  • N20–N23 Urolithiasis
  • N25–N29 Other disorders of kidney and ureter
  • N30–N39 Other diseases of urinary system
  • N40–N51 Diseases of male genital organs
  • N60–N64 Disorders of breast
  • N70–N77 Inflammatory diseases of female pelvic organs
  • N80–N98 Noninflammatory disorders of female genital tract
  • N99 Other disorders of genitourinary tract

Other sections that may pertain to Urology include conditions originating in the perinatal period (P00-P9) Certain infectious and parasitic diseases (A00-B99) Complications of pregnancy, childbirth and the puerperium (O00-O9A) Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Endocrine, nutritional, and metabolic diseases (E00-E88) Injury, poisoning and certain other consequences of external causes (S00-T88) Neoplasms (C00-D49) Symptoms, signs, and abnormal clinical and laboratory findings, NEC (R00-R94).

Comparison of ICD-9-CM and ICD-10-CM Codes for Urology

Urinary tract infection ICD-9

  • 599.0 Urinary tract infection, site not specified

ICD-10

  • N39.0 Urinary tract infection, site not specified **Use additional code (B95-B97) to identify infectious agent
  • N30.00 Acute cystitis without hematuria
  • N30.01 Acute cystitis with hematuria
  • N30.10 Interstitial cystitis (chronic) without hematuria
  • N30.11 Interstitial cystitis (chronic) with hematuria
  • N30.20 Other chronic cystitis without hematuria
  • N30.21 Other chronic cystitis with hematuria
  • N30.30 Trigonitis without hematuria
  • N30.31 Trigonitis with hematuria
  • N30.40 Irradiation cystitis without hematuria
  • N30.41 Irradiation cystitis with hematuria
  • N30.80 Other cystitis without hematuria
  • N30.81 Other cystitis with hematuria
  • N30.90 Cystitis, unspecified without hematuria
  • N30.91 Cystitis, unspecified with hematuria
  • N15.9 Renal tubule-interstitial disease, unspecified
  • N34.1 Nonspecific urehtritis
  • N34.2 Other urethritis

Urethral Stricture ICD-9

  • 598.9 Urethral stricture, unspecified

ICD-10

  • N35.010 Post-traumatic urethral stricture, male, meatal
  • N35.011 Post-traumatic bulbous urethral stricture
  • N35.012 Post-traumatic membranous urethral stricture
  • N35.014 Post-traumatic urethral stricture, male, unspecified
  • N35.9 Urethral stricture, unspecified
  • N35.013 Post-traumatic anterior urethral stricture
  • N35.021 Urethral stricture due to childbirth
  • N35.028 Other post-traumatic urethral stricture, female
  • N35.111 Postinfective urethral stricture, not elsewhere classified, male, meatal
  • N35.112 Postinfective bulbous urethral stricture, not elsewhere classified
  • N35.113 Postinfective membranous urethral stricture, not elsewhere classified
  • N35.114 Postinfective anterior urethral stricture, not elsewhere classified
  • N35.119 Postinfective urethral stricture, not elsewhere classified, male, unspecified
  • N35.12 Postinfective urethral stricture, not elsewhere classified, female
  • N35.8 Other urethral stricture, unspecified

Neoplasm ICD-9

  • 188.9 Malignant neoplasm of bladder, part unspecified

ICD-10

  • C67.9 Malignant neoplasm of bladder, unspecified
  • 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

Incontinence ICD-9

  • 788.30 Urinary incontinence, unspecified

ICD-10

  • R32 Unspecified urinary incontinence
  • R39.81 Functional urinary incontinence
  • F98.0 Non-organic origin **There are more specific code choices available in ICD-10-CM. These include: **Code also any associated overactive bladder (N32.81)
  • N39.3 Stress incontinence (female) (male) **Code also any associated overactive bladder (N32.81)
  • N39.41 Urge incontinence
  • N39.42 Incontinence without sensory awareness
  • N39.43 Post-void dribbling
  • N39.44 Noctural enuresis
  • N39.45 Continuous leakage
  • N39.46 Mixed incontinence
  • N39.490 Overflow incontinence

Join Our Newsletter

Get Updates Direct to Your Inbox. Gain access to a rich library of articles, white papers, webinars, podcasts and more. Register today to receive eMDs Insights newsletter.

*
*
*
*
Specialty *
State *