Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 17: Diseases of the Genitourinary System (N00–N99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the genitourinary system and related procedures?

3. Chapter 14 of ICD-10-CM, Diseases of the Genitourinary System, N00–N99 The blocks of codes for Chapter 14 in ICD-10-CM are: Glomerular disease Renal tubulo-interstitial diseases Acute kidney failure and chronic kidney disease Urolithiasis Other disorders of kidney and ureter Diseases of male genital organs Disorders of breast Inflammatory diseases of female pelvic organs Noninflammatory disorders of female genital tract Intraoperative and postprocedural complications

4. Instructional Notes for ICD-10-CM Chapter 14 Includes notes clarify the types of disorders, for example: N00 Acute nephritis syndrome includes acute glomerular disease, acute glomerulonephritis and acute nephritis Instructional notes appear throughout the chapter to remind the coder to, for example: Code also any associated kidney failure Use additional code to identify infectious agent Code also associated underlying condition Coder first any associated (certain) condition Use additional code to identify kidney transplant status

5. Instructional Notes for ICD-10-CM Chapter 14 Notes appear to explain other diagnosis terminology that could be classified to a particular category or code Includes notes appear throughout Chapter 14 in ICD-10-CM to confirm all the terminology for diseases that are included in various categories Excludes1 notes identify conditions that cannot be coded with certain category codes in Chapter 14 Excludes2 notes identify other conditions that can be coded with category codes in Chapter 14

6. Coding Guidelines for ICD-10-CM Chapter 14 There are chapter-specific guidelines for Chapter 14 in the ICD-10-CM Official Guidelines for Coding and Reporting that addresses Stages of chronic kidney disease (CKD) Chronic kidney disease and kidney transplant status Chronic kidney disease with other conditions

7. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Hematuria is the presence of blood or red blood cells in the urine. It can be a symptom of an undiagnosed disease or hematuria can be present with another condition in the genitourinary tract. Hematuria may be further described as Gross hematuria Microscopic hematuria Recurrent, persistent or idiopathic

8. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Renal failure and renal insufficiency represent a range of disease processes that occur when the kidneys have problems eliminating metabolic products from the blood These conditions may be caused by various underlying conditions such as hypertension and diabetes Acute and chronic forms of kidney disease are classified with different codes in ICD-10-CM

9. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Chronic kidney disease (CKD) is the proper term for other conditions such as chronic renal failure or chronic renal insufficiency CKD has five stages of disease based on the glomerular filtration rate (GFR) Patients are considered as having end-stage renal disease when the patient requires dialysis or a kidney transplant

10. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Acute kidney failure or acute renal failure usually occurs suddenly as the result of physical trauma, infection, inflammation or toxicity Symptoms include oliguria or anuria with hyperkalemia and pulmonary edema The types of acute kidney failure may be described according to the underlying cause, such as: Prerenal Intrarenal Postrenal

11. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Cystitis is a bacterial infection of the urinary bladder. In females, most cases are due to vaginal infection that extends through the urethra to the bladder In males, cystitis is due to urethral or prostatic infections or catheterizations ICD-10-CM classifies cystitis according to the type, severity and location. The codes also identify whether or not hematuria is present with cystitis An additional code is used to identify the infectious agent when applicable.

12. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 The diagnosis of an enlarged prostate may also be stated as benign prostatic hypertrophy (BPH) The prostate gland, which encircles the urethra at the base of the bladder, becomes enlarged and presses on the urethra, obstructing the flow of urine from the bladder This is known as benign bladder neck obstruction (BNO) Symptoms of an enlarged prostate may be referred to as lower urinary tract symptoms or LUTS ICD-10-CM classifies enlarged or nodular prostate with and without lower urinary tract symptoms

13. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Disorders of the breast include gynecomastia, fibrocystic disease, inflammatory disease and solitary cyst of the breast Certain signs and symptoms of breast disease are included in this chapter, such as mastodynia, induration of breast and nipple discharge Specific codes describe conditions of the breast related to staged breast reconstruction following full or partial mastectomy

14. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Inflammatory disease of female pelvic organs A note at the beginning of several category codes state “use additional code to identify infectious agent” Codes distinguish between acute and chronic salpingitis and oophoritis Other categories identify inflammatory diseases that are the result of another disease

15. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Noninflammatory disorders of the female genital tract includes conditions such as Endometriosis with specific codes for the common sites such as ovary, fallopian tube, pelvic peritoneum, etc. Female genital prolapse for urethrocele, cystocele, uterovaginal prolapse, vaginal enterocele, rectocele and other weakening of tissue and pelvic muscle wasting Fistula involving the female genital tract Disorders of the ovary, fallopian tube and broad ligament for example cysts, torsion, hematosalpinx and hematoma of broad ligament Endometrial hyperplasia, benign and with atypica

16. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Codes include descriptions of such conditions as mild cervical dysplasia or cervical intraepithelial neoplasia I (CIN I) or moderate dyplasia of cervix (CIN II) or unspecified form of cervical dysplasia Codes describe vulvar intraepithelial neoplasia I and II (VIN I and VIN II) which may also be known as mild dyplasia of vulva and moderate dysplasia of vulva Severe forms of dyplasia of cervix or vulva, also known as CIN III or VIN III or carcinoma in situ of these sites, are classified to the neoplasm chapter

17. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 The diagnosis of menopause or menopausal symptoms needs to be more specific for accurate coding Codes exist for both symptomatic menopausal syndrome and asymptomatic menopausal status Use additional code for associate symptoms is included The codes within this chapter describe menopause and female climacteric states Other chapters include codes for asymptomatic and symptomatic postprocedural ovarian failure, asymptomatic and symptomatic premature menopause or asymptomatic menopausal state

18. Coding Diseases of the Genitourinary System in ICD-10-CM Chapter 14 Intraoperative and postprocedural complications include: Postprocedural kidney failure Postprocedural urethral stricture Postprocedural pelvic peritoneal adhesions Accidental puncture and laceration of a genitourinary system organ or structure during a procedure Complications of cystostomy and other external stoma of the urinary system are included in Chapter 14

19. Coding Procedures of the Genitourinary System in ICD-10-PCS Include procedures on the urinary system, female reproductive system and male reproductive system See Table 17.1 for the root operations for the genitourinary system Body parts include laterality for specific organs The approach for these procedures are frequently endoscopic Robotic assisted prostatic and uterine procedures are becoming more common

20. Exercises Practice coding the conditions included in Chapter 14 of ICD-10-CM for diseases of the genitourinary system as well as the procedures used to treat these conditions by completing the review exercises for Chapter 17.