ICD-10cm – 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update! (Part 2)

ICD-10cm – 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update!  (Part 2)

November 2, 2016

As we discussed in part one, the ICD-10CM code set used within the United States is maintained by the ICD Coordination and Maintenance Committee.  It is this organization that is responsible for putting for the additions, deletions, and updates to ICD-10-cm code set on a yearly basis.  This committee includes representatives from the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). 

The ICD-10cm guidelines, as well as the actual numeric code set, should be reviewed frequently and used as a vital companion reference when coding for diagnosis in physician based and clinical diagnosis services.  As a coding procedure, it is necessary to review all sections of the guidelines to fully understand all of the rules, procedural and instructional processes needed to code clinical documentation presented in the medical records properly. 

The complete ICD-10cm guidelines can be found at the beginning of your ICD-10cm 2017 book and/or e-files.   The new updates for the ICD-10 code set for 2017 actually went into effect on 10/01/2017.  If you haven’t downloaded the new codes, or purchased your books yet, you really need to!  Access to the new updates and revisions is an essential tool for coders and clinical providers.

As we look at some of the codes that affect Urology (genitourinary)  there are a couple of areas that include both male and female gender codes.  Even though we think of the “N” codes as primarily genito-urinary, some of the breast codes are also within the “N” code-set and affect both male and female gender.  Be aware that some carriers have edits in place, that some carriers use edits and tag certain diagnoses as “female” only codes, when in fact they should be for both genders.  If you are getting an edit or denial for an inappropriate gender, be sure to appeal, or contact the carrier/payer so the edit can be corrected. 

Most of the changes in the Urologic code-set is for the codes involving renal tubule-intersitial diseases within the codes of N10 – N16.  Of these the N10 is truly a three-character code, and the revision has been made to make it easier to understand. 

Revise from        N10 Acute tubulo-interstitial nephritis

Revise to           N10 Acute pyelonephritis

Revise from        Acute pyelonephritis

Revise to          Acute tubulo-interstitial nephritis

To completely understand this code revision, be aware that an Acute interstitial nephritis can be the cause of acute renal failure complicated by medications, infection, and/or other causes.  However, with this verbiage change, the physician or provider will only need to provide documentation for  "Acute Pyelonephiritis"  then if more documentation is found, the acute tubulo-interstitial nephritis will fall under this code set.

The next change is for the codeset of N13.  Within this code set there was an addition of the code N13.0 to denote hydronephrosis with a UPJ obstruction.  ICD-10cm also includes guideline direction for an excludes 2 note for the N13.0.  In addition, it includes the revision for verbiage in the N13.6 pyonephrosis code and expanded out that code set.  

Add     N13.0 Hydronephrosis with ureteropelvic junction obstruction

Add  Hydronephrosis due to acquired occlusion of ureteropelvic junction

Add          Excludes2: Hydronephrosis with ureteropelvic junction obstruction due to calculus (N13.2)

No Change     N13.6 Pyonephrosis

Revise from  Conditions in N13.1-N13.5 with infection

Revise to      Conditions in N13.0-N13.5 with infection

As we look at the codes within the code set of N30 – N39 Other diseases of the urinary system,  there were minimal changes, however, the N36.0 Urethral Fistula code had a small revision change, as the excludes 1 notes, show an expanded out code from N50.8  to N50.89 which is now a five-character code from a four-character code.

In the codes for other specified disorders of the urethra code N36.8;  ICD-10cm now denotes an "Excludes 1" notation 

No Change   N36.8 Other specified disorders of urethra

Add     Excludes1: congenital urethrocele (Q64.7)

           Add   female urethrocele (N81.0)

A small verbiage change was made for the code N39.42 as they added the diagnosis of insensible (urinary) incontinence under the code N39.42

No Change   N39.42 Incontinence without sensory awareness

                    Add Insensible (urinary) incontinence

The code set for N39.49 Other specified urinary incontinence actually added two new codes for 2017.  These additions are very important as the previous code set we had to choose a much more vague diagnosis, where these new codes give us much better specificity. 

Add N39.491 Coital incontinence

Add N39.492 Postural (urinary) incontinence

The next area of revision is within the codes specific to the male genital organs, and specifically regarding the prostate.  The N40 code set simply added some verbiage revisions  however, the N42.3 code set for dysplasia of prostate includes deletions within verbiage.  Below outlines the added new codes, which encompass the deletion verbiage within the previous "excludes" notes. 

No Change N42.3 Dysplasia of prostate

Delete Prostatic intraepithelial neoplasia I (PIN I)

Delete Prostatic intraepithelial neoplasia II (PIN II)

Delete Excludes1: prostatic intraepithelial neoplasia III (PIN III) (D07.5)

Add N42.30 Unspecified dysplasia of prostate

Add N42.31 Prostatic intraepithelial neoplasia

Add PIN

Add Prostatic intraepithelial neoplasia I (PIN I)

Add Prostatic intraepithelial neoplasia II (PIN II)

Add Excludes1: prostatic intraepithelial neoplasia III (PIN III) (D07.5)

Add N42.32 Atypical small acinar proliferation of prostate

Add N42.39 Other dysplasia of prostate

The N50 Other and unspecified disorders of male genital organs code set includes codes for much better specificity for genital pain.  ICD-10cm 2017 deleted many diagnoses that were previously housed within the code set to now having a specific diagnosis added for better specificity.  This is a huge boon to coders that previously used the non-specified codes for testicular pain and scrotal pain.   As you can see below, there is also added specificity for laterality on the testes.

No Change N50.8 Other specified disorders of male genital organs

Delete Atrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens

Delete Edema of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens

Delete Hypertrophy of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens

Delete Ulcer of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens

Delete Chylocele, tunica vaginalis (nonfilarial) NOS

Delete Urethroscrotal fistula

Delete Stricture of spermatic cord, tunica vaginalis, and vas deferens

Add N50.81 Testicular pain

Add N50.811 Right testicular pain

Add N50.812 Left testicular pain

Add N50.819 Testicular pain, unspecified

Add N50.82 Scrotal pain

Add N50.89 Other specified disorders of the male genital organs

Add Atrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens

Add Chylocele, tunica vaginalis (nonfilarial) NOS

Add Edema of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens

Add Hypertrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas

deferens

Add Stricture of spermatic cord, tunica vaginalis, and vas deferens

Add Ulcer of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens

Add Urethroscrotal fistula

ICD-10cm 2017 also addressed the erectile dysrunction codes and revised the verbiage, in addition to adding new codes for specificity.  The subtle verbiage change of "post surgical"  to "post procedural" is a huge change in interpretation for coding and payer compensation.  In addition to verbiage changes, the addition of four new codes will really enhance the coding specificity for urologic surgical procedures in relation to erectile dysfunction. The breakout below shows these revisions and additions.

Revise from N52.3 Post-surgical erectile dysfunction

Revise to     N52.3 Postprocedural erectile dysfunction

Add N52.35 Erectile dysfunction following radiation therapy

Add N52.36 Erectile dysfunction following interstitial seed therapy

AddN52.37 Erectile dysfunction following prostate ablative therapy

Add Erectile dysfunction following cryotherapy

Add Erectile dysfunction following other prostate ablative therapies

Add Erectile dysfunction following ultrasound ablative therapies

Revise from N52.39 Other post-surgical erectile dysfunction

Revise to     N52.39 Other and unspecified postprocedural erectile dysfunction

In part 1 of this article series we also addressed the mastitis codes below. Again, these codes are not necessarily "gender specific" and mastitis can develop in both male and female breasts.   We included these in both part 1 and part 2 of this series, as these codes truly cross the gender male/female anatomy boundaries.

ICD-10cm 2017 added

Add N61.0 Mastitis without abscess

Add Infective mastitis (acute) (nonpuerperal) (subacute)

Add Mastitis (acute) (nonpuerperal) (subacute) NOS

Add Cellulitis (acute) (nonpuerperal) (subacute) of breast NOS

Add Cellulitis (acute) (nonpuerperal) (subacute) of nipple NOS

Add N61.1 Abscess of the breast and nipple

Add Abscess (acute) (chronic) (nonpuerperal) of areola

Add Abscess (acute) (chronic) (nonpuerperal) of breast

Add Carbuncle of breast

Add Mastitis with abscess

The N64 category only had a minor change in the revision from a 5-character code to a 6-character code.

No Change N64.1 Fat necrosis of breast
No Change Code first

  Revise from:  breast necrosis due to breast graft (T85.89)

  Revise to: breast necrosis due to breast graft (T85.898)

This is also a "repeat" of information from part 1, in this 2 part series.  As we have previously reviewed for ICD-10cm 2017 pertaining to both urologic and gynecologic surgery, The following codes were revised and added to separate out terms that were previously combined. 

In N99.92 it states “Postprocedural hemorrhage and hematoma” and this was revised to simply be “post procedural” hemorrhage.  ICD-10 then included expansion for a 6^th character for added specificity.   The verbiage removal of “hematoma” was then added to seroma and added to the code set N99.84, with the expansion of the 6^th character for increased specificity. 

·         Revise from: N99.82 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a procedure

·         Revise to:  N99.82 Postprocedural hemorrhage of a genitourinary system organ or structure following a procedure

o    Revise from N99.820 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure

o    Revise to N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure

o    Revise from N99.821 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following other procedure

o    Revise to N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure

·         Add N99.84 Postprocedural hematoma and seroma of a genitourinary system organ or structure following a procedure

o    Add N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure

o    Add N99.841 Postprocedural hematoma of a genitourinary system organ or structure following other procedure

o    Add N99.842 Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure

o    Add N99.843 Postprocedural seroma of a genitourinary system organ or structure following other procedure

As ICD-10cm continues to be improved, we should also remember the goal of working hand in hand with the clinical providers of care to ensure that the clinical documentation of the patient record is clearly reflected by the procedure and diagnosis codes chosen and billed to the insurance payers.  The patients’ medical record documentation is essential for determining the most appropriate codes and reimbursement.  Failing to provide clear, concise and accurate documentation can lead to incorrect and/or inaccurate medical care and diagnosis; inappropriate or incorrect claims for services; claim denials or the worst case scenario of allegation of fraud/abuse.    The verbiage revisions,  added codes and expanded code set characters within ICD-10cm in 2017 is a welcome addition to making our job as coders that much better.

Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience.  Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding.  She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.