Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

1. Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition Chapter 13: Diseases of the Genitourinary System

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

3. Genitourinary System • Urinary system disorders in ICD-9-CM • Nephritis, nephrotic syndrome, and nephrosis (580–589) • Other diseases of urinary system (590–599)

4. Nephrosis, Nephrotic Syndrome, and Nephrosis Coding in ICD-9-CM • Important “excludes note” at the beginning of the section • Hypertension and kidney disease is coded with combination codes in Chapter 7 of ICD-9-CM

5. Genitourinary System in ICD-9-CM • Older terminology includes chronic renal failure or chronic renal insufficiency • Newer terminology is chronic kidney disease • ICD-9-CM Category 585 • Five stages based on glomerular filtration rate

6. Genitourinary System (continued) • Acute renal failure vs. acute renal insufficiency • Acute renal failure (ICD-9-CM category 584) • May occur suddenly as a result of physical trauma, infection, inflammation, or toxicity • Prerenal, intrarenal, or postrenal • Acute renal insufficiency (ICD-9-CM code 593.9) • Vague, different condition

7. Other Diseases of Urinary System (ICD-9-CM Categories 590–599) • Many genitourinary infections coded here • Requires an additional code to identify the organism involved, such as E. coli • Common infections coded in ICD-9-CM • Pyelonephritis (590) • Cystitis (595) • Urethritis (597) • Urinary tract infection (599.0)

8. Other Diseases of Urinary System (ICD-9-CM Categories 590–599) • Cystitis • Bacterial infection of the urinary bladder • Diagnosis made by obtaining a urine specimen • Bacterial colony count of more than 1,000 colonies/ml in a catheterized specimen indicates cystitis • Bacterial count of more than 100,000 ml in a midstream sample indicates cystitis

9. Other Diseases of Urinary System (ICD-9-CM Categories 590–599) • Cystitis • Cystitis is classified to category 595 with the fourth-digit subcategories describing type, severity, and location • An instruction states that an additional code from chapter 1, Infectious and Parasitic Diseases, should be assigned to identify the organism involved

10. Other Diseases of Urinary System (ICD-9-CM Categories 590–599) • Hematuria • Presence of blood or red blood cells in the urine • Gross hematuria is visible to the naked eye • Microscopic hematuria is visible only under the microscope • Caused by underlying urinary conditions • Infections, benign prostatic hypertrophy and kidney and ureteral calculi • Cardinal sign of bladder cancer

11. Other Diseases of Urinary System (ICD-9-CM Categories 590–599) (continued) • Other conditions within this section • Calculus of kidney and ureter (592) • Calculus of lower urinary tract (594) • Other disorders of urinary bladder (596) • Urethral stricture (598) • Important instruction: Use additional code to identify urinary incontinence

12. Other Diseases of Urinary System (ICD-9-CM categories 590–599) (continued) • Hematuria is the presence of blood or red blood cells in the urine; unspecified type (599.70) • Gross hematuria (599.71)—blood is visible • Microscopic hematuria (599.72)—blood is only visible under the microscope • Hematuria is a symptoms of many underlying urinary conditions including bladder cancer

13. Genitourinary System in ICD-9-CM (continued) • Male and female genital system disorders: • Diseases of male genital organs (600–608) • Disorders of breast (610–611) • Inflammatory disease of female pelvic organs (614–616) • Other disorders of female genital tract (617–629)

14. Benign Prostatic Hypertrophy • ICD-9-CM Category 600 codes • Enlargement of the male prostate gland • Benign prostatic hyperplasia • Causes bladder neck obstruction • Lower urinary tract symptoms (LUTS) • Frequency, urgency, nocturia, incontinence, and hesitancy

15. Hyperplasia of Prostate (ICD-9-CM Category 600) (continued) • Importance of recognizing many symptoms of prostate enlargement • Under each code for BPH with obstruction, a directional note states “Use additional code to identify symptoms” • Multiple symptom codes may be used to describe the patient’s condition

16. Benign Prostatic Hypertrophy • Fifth digits with category 600 describe the type of hypertrophy or hyperplasia of prostate • Whether or not urinary obstruction or urinary retention is present • Use additional code to identify symptoms • Codes describe incomplete bladder emptying, nocturia, straining on urinary, urinary frequence, hesitancy, incontinence, obstruction, retention, urgency, or weak urinary stream

17. Disorders of Breast (ICD-9-CM Categories 610–611) • Disorders include gynecomastia, fibroadenosis, inflammatory disease and solitary cyst of the breast • ICD-9-CM Category 611 includes signs and symptoms of breast disease • Neoplasms of the breast are coded to chapter 2 of ICD-9-CM • Specific conditions requiring reconstruction of breast

18. Disorders of Female Genital Tract (617–629) • Disorders of the female genital tract include • Endometriosis—endometrial glands or stoma are present outside the uterine cavity • Genital prolapse includes prolapse of the vaginal walls with or without uterine prolapse • Ovarian cysts

19. Other Disorders of Female Genital Tract (ICD-9-CM Categories 617–629) • Other gynecological conditions in this chapter • Noninflammatory disorders of the female genital tract including dysplasia of cervix or vulva • Disorders of menstruation • Menopausal and postmenopausal disorders • Infertility

20. Abnormal Pap Smear Findings • Bethesda System used for reporting results in ICD-9-CM • Descriptive diagnoses included in the Bethesda model include • Nonneoplastic findings such as reactive cellular changes • Epithelial cell abnormalities • Glandular cell abnormalities

21. Abnormal Pap Smear Findings • ICD-9-CM contains codes 622.10–621.12 to describe mild, moderate, and unspecified dysplasia of cervix • ICD-9-CM contains codes 624.01–624.02 to describe vulvar intraepithelianeoplasia I and II

22. Abnormal Pap Smear Findings (continued) • ICD-9-CM Subcategory 795.0 with fifth digits are used to describe the results of abnormal Pap smears of the cervix and cervical HPV • ICD-9-CM Alphabetic Index entries are “Findings, abnormal, Papanicolaou” or “Papanicolaou smear”

23. Abnormal Pap Smear Findings (continued) • ICD-9-CM Subcategory 795.1 with fifth digits are used to describe the results of abnormal Pap smears of the vagina and vaginal HPV • Pap smears of the vagina and vulva are performed in women who do not have a uterus or cervix as the result of surgery and require the same cancer prevention and screening procedures

24. Menopause • ICD-9-CM codes exist for symptomatic vs. asymptomatic menopause status • Condition can be the result of • Natural aging process or • Surgical intervention or other treatment such as radiation • Menopausal disorder includes symptoms

25. Menopause (ICD-9-CM coding continued) • Menopausal disorder or symptom associated with artificial or postsurgical menopause (256.2, 627.4) • Menopausal status as a result of oophorectomy (256.2, V45.77) • Menopausal disorder associated with age-related or naturally occurring menopause (256.39, 627.2) • Asymptomatic woman with age-related menopause (V49.81)

26. Chapter 14 of ICD-10-CM, Diseases of the Genitourinary System, N00–N99 Some of the blocks in ICD-10-CM are: Glomerular disease Renal tubulo-interstitial diseases Acute kidney failure and chronic kidney disease Urolithiasis Diseases of male genital organs Disorders of breast Inflammatory diseases of female pelvic organs Noninflammatory disorders of female genital tract Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified

27. Coding Guidelines and Instructional Notes for ICD-10-CM Chapter 14 Throughout ICD-10-CM chapter 14 are includes notes to clarify the types of disorders are classified to the various categories Coding guidelines state that chronic kidney disease and kidney transplant status can be coded for the same patient Guidelines address coding the complications of a kidney transplant

28. Coding Overview for ICD-10-CM Chapter 14 Chronic kidney disease (N18) is divided into stages I, II, III, IV, V and end-stage renal disease Combination codes exist to identify the presence of an infection with or without hematuria Terminology of benign prostatic hypertrophy or hyperplasia replaced with term “enlarged prostate” Intraoperative and postprocedural complications of the genitourinary system are included in Chapter 14

29. Coding Overview for ICD-10-CM Chapter 14 Notes are available to indicate an additional code should be used, for example: N17, Acute kidney failure: Code also any associated underlying condition N18, Chronic kidney failure: Code first any associated diabetic chronic kidney disease, hypertensive chronic kidney disease with a use additional code to identify kidney transplant status, if applicable

30. Coding Overview for ICD-10-CM Chapter 14 Notes are available to indicate an additional code should be used, for example: N30, Cystitis—Use additional code to identify infectious agent N31, Neuromuscular dysfunction of bladder, NEC—Use additional code to identify any associated urinary incontinence N33, Bladder disorders in diseases classified elsewhere—Code first underlying disease N40, Enlarged prostate with lower urinary tract symptoms (LUTS)—Use additional code for associated symptoms, when specified