The International Statistical Classification of Diseases and Related Health Problems (ICD) is a medical classification list owned by the World Health Organization (WHO). The United States has used their own Clinical Modification (-CM) of the 10th revision (ICD-10) for coding medical encounters since October 1, 2015. ICD-10-CM is updated yearly by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). New codes become active on October 1 of the calendar year. Updates may take the form of additions, deletions, and wording changes. The updated and new codes that maybe of interest to urologists that will be activated on October 1, 2018 are described herein.
Abnormal Levels in Urine Collection: New Codes
Patients who form kidney stones often have their urine sent away for diagnostic testing, looking for abnormal levels of urine substances that may alter their risk of stone formation. When identified, therapy can be directed at those abnormalities. Common abnormalities include elevated levels of urine calcium (hypercalciuria), elevated levels of urine oxalate (hyperoxaluria), low levels of citrate (hypocitraturia), and high levels of uric acid (hyperuricosuria). However, there are no specific ICD-10 codes for these conditions. It is important to differentiate idiopathic or dietrelated hyperoxaluria from primary hyperoxaluria, an inborn error of metabolism that is often discovered in childhood, which currently is coded in ICD-10 at E72.53. Therefore, ICD-10-CM will add five new codes to the R82.99 section while adding an exclusion for primary hyperoxaluria for R82.992 (Table 1).
Table 1.
New Codes for Other and Unspecified Abnormal Findings in the Urine
| R82.9 Other and unspecified abnormal findings in urine |
| R82.9 Other and unspecified abnormal findings in urine |
| R82.99 Other abnormal findings in urine |
| Delete Cells and casts in urine |
| Delete Crystalluria |
| Delete Melanuria |
| New Code R82.991 Hypocitraturia |
| New Code R82.992 Hyperoxaluria |
| Add Excludes1: Primary Hyperoxaluria (E72.53) |
| New Code R82.993 Hyperuricoscuria |
| New Code R82.994 Hypercalciuria |
| New Code R82.998 Other abnormal findings in urine |
| Cells and casts in urine |
| Crystalluria |
| Melanouria |
| Hypomagnesuria |
Pyuria
Pyuria is defined as the presence of white blood cells (leukocytes) in the urine. It is a marker of urinary tract inflammation but also is a nonspecific finding as there are many potential etiologies of pyuria. Pyuria can be seen in patients with urinary tract infections, urinary stones, other urinary diseases, or can be idiopathic. Sterile pyuria is more specifically the finding of white cells in the urine without bacteria being detected or other etiologies of pyuria that can be found. Pyuria had been indexed to code N39.0, Urinary tract infection unspecified, so did not have its own unique code. To help differentiate the condition of pyuria as a sign or symptom without a diagnosis, a unique code was created. At this time it was felt that there was not enough support to differentiate the nonspecific finding of pyuria with the specific finding of sterile pyuria, so they are currently indexed to the same ICD-10-CM code (Table 2).
Table 2.
New Code for Pyuria
| R82 Other and unspecified abnormal findings in urine |
| R82.9 Other and unspecified abnormal findings in urine |
| New code R82.92 Pyuria |
| Add (description) Sterile pyuria |
Urethral Stricture: “Overlapping Sites”
The ICD-10-CM codes for non-congenital male urethral strictures have specific codes for the location of the stricture, such as the meatus, anterior urethra, bulbar urethra, and membranous urethra. However, there are no specific ICD-10-CM codes for patients who have strictures of overlapping sites or a pan-urethral stricture. New male urethral stricture codes will be added to describe urethral strictures of overlapping sites (Table 3), whether the etiology is post-traumatic, post-infective, or post-procedural.
Table 3.
New Codes for Urethral Strictures of Overlapping Sites
| N35.01 | Post-traumatic urethral stricture, male | |
| New Code | N99.116 Postprocedural urethral stricture, overlapping sites | |
| N35.11 | Postinfective urethral stricture, male | |
| New Code | N35.116 Postinfective urethral stricture, overlapping sites | |
| N99.11 | Postprocedural urethral stricture, male | |
| New Code | N99.116 Postprocedural urethral stricture, overlapping sites |
Urethral Stricture: Other and Unspecified
Similarly, etiologies for urethral strictures in ICD-10-CM are limited to congenital, post-traumatic, post-infective, and post-procedural. In the current practice of medicine, when a patient presents with a urethral stricture, the underlying etiology may be due to a different cause or unspecified. Therefore, seven new codes will be introduced for both N35.8 Other urethral stricture and N35.9 Urethral stricture, unspecified (Table 4).
Table 4.
New Codes for Urethral Stricture of Etiology Other Urethral Stricture and Urethral Stricture, Unspecified
| N35.8 | Other urethral stricture | |
| New Sub-category N35.81 Other urethral stricture, male | ||
| New Code | N35.811 Other urethral stricture, male, meatal | |
| New Code | N35.812 Other urethral bulbar stricture, male | |
| New Code | N35.813 Other membranous urethral stricture, male | |
| New Code | N35.814 Other anterior urethral stricture, male | |
| New Code | N35.816 Other urethral stricture, male, overlapping sites | |
| New Code | N35.819 Other urethral stricture, unspecified site | |
| New Code | N35.82 Other urethral stricture, female | |
| N35.9 | Urethral stricture, unspecified | |
| New Sub-category N35.91 Urethral stricture, unspecified, male | ||
| New Code | N35.911 Unspecified urethral stricture, male, meatal | |
| New Code | N35.912 Unspecified urethral bulbar stricture, male | |
| New Code | N35.913 Unspecified membranous urethral stricture, male | |
| New Code | N35.914 Unspecified anterior urethral stricture, male | |
| New Code | N35.916 Unspecified urethral stricture, male, overlapping sites | |
| New Code | N35.919 Unspecified urethral stricture, unspecified site | |
| New Code | N35.92 Unspecified urethral stricture, female |
Neoplasm Unspecified Behavior of Testis
Male patients may present to a provider with a complaint of a growth or mass in the testicle detected by a complaint or felt on examination or detected by an imaging study performed for genitourinary or non-genitourinary reasons. In these situations, further testing (imaging, laboratory tests) and/or procedures (such as biopsy or surgery) may be indicated, even though no definitive diagnosis has yet been made. The differential diagnosis of a neoplasm of the testicle includes a variety of both malignant and nonmalignant conditions. One should never give a patient a cancer diagnosis without proving cancer, lest it follow them for the rest of their life. Because ICD-10-CM currently has no unique codes to describe the condition of a mass in the testicle that is yet unspecified, four new specific ICD-10-CM codes were created in the D49.5 section for patients with a neoplasm of unspecified behavior of testicle (Table 5), with specific codes for the right testes, left testis, bilateral testes, or unspecified testis.
Table 5.
New Codes for Neoplasm Unspecified Behavior of Testis
| D49 | Neoplasms of unspecified behavior | ||
| D49.5 | Neoplasm of unspecified behavior of other genitourinary organs | ||
| New Sub-subcategory | D49.52 Neoplasm of unspecified behavior of testis, testes | ||
| New Code | D49.521 Neoplasm of unspecified behavior of right testis | ||
| New Code | D49.522 Neoplasm of unspecified behavior of left testis | ||
| New Code | D49.523 Neoplasm of unspecified behavior of testes, bilateral | ||
| New Code | D49.529 Neoplasm of unspecified behavior of unspecified testis |
Abnormal Findings on Diagnostic Imaging of Testis
Similarly, patients may be found to have an abnormality of the testicle or testes detected on an imaging study performed for genitourinary or non-genitourinary reasons, and further testing and/or procedures would be indicated. The abnormality may be a mass or may not be a mass, so this ends up being a sign or symptom without a definitive diagnosis. Currently, there are no unique code for reporting abnormal findings on diagnostic imaging of testis, so new codes were created in the R93.8 category to allow accurate coding for patients who present in this way (Table 6).
Table 6.
New Codes for Abnormal Findings on Diagnostic Imaging of Testis, Testes
| R93 | Abnormal findings on diagnostic imaging of other body structures | |
| R93.8 | Abnormal findings on diagnostic imaging of other specified body structures | |
| New Sub-subcategory R93.81 Abnormal radiologic findings on diagnostic imaging of testis, testes | ||
| New Code R93.811 Abnormal radiologic findings on diagnostic imaging of right testis | ||
| New Code R93.812 Abnormal radiologic findings on diagnostic imaging of left testis | ||
| New Code R93.813 Abnormal radiologic findings on diagnostic imaging of testes, bilateral | ||
| New Code R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testis |
Conclusions
It is vitally important that providers and billing staff are aware of the changes that occur at the annual ICD-10-CM updates, specifically to the changes that may affect their individual practice. This article will help urologists and those who treat genitourinary conditions prepare.
