ICD-10-CM replaced ICD-9 for coding medical visits in the United States on October 1, 2015. A moratorium on additions, deletions, or changes to the coding system was placed for 1 year after initial implementation. Therefore, a backlog of changes developed. The initial round of changes that were recommended will be introduced on October 1, 2016. The number of changes may be higher now than in future years due to this initial backlog. In total, there will be 1943 new codes introduced, along with 422 “revised from” codes (and therefore also 422 “revised to” codes, representing changes based upon wording changes or changes based upon the need to add or delete codes within the same section). In addition, 305 codes will be deleted. There are a number of urology code changes, or codes that will be changed that are of interest to urologists, that are described here.

More Detailed Codes for Neoplasm of Unspecified Behavior of Other Genitourinary Organs

In the initial version of ICD-10-CM, there were two codes for unspecified neoplasms of the genitourinary tract: D49.4 Neoplasm of unspecified behavior of the bladder, and D49.5 Neoplasm of unspecified behavior of other genitourinary organs. To increase specificity, D49.5 will be deleted and replaced with three more specific codes that add the specific organ (kidney) and laterality to this section: D49.511 Neoplasm of unspecified behavior of right kidney, D49.512 Neoplasm of unspecified behavior of left kidney, and D49.519 Neoplasm of unspecified behavior of unspecified kidney. There will be a new code, D49.59 Neoplasm unspecified behavior of other genitourinary organ, which should be used for other genitourinary organs.

Wording Change for Acute Pyelonephritis

In ICD-10, N10 is described as Acute tubulointerstitial nephritis. However, starting on October 1, 2016, the wording of this code will be changed to the terminology more commonly used in the United States, which is Acute pyelonephritis.

Reactivated Ureteropelvic Junction Obstruction Code

When ICD-10-CM was introduced to the United States, the code N13.0 Hydronephrosis with ureteropelvic junction obstruction had been deactivated. Because this is a condition commonly seen and this oversight was identified, the code will be reactivated. The related codes Q62.11 Congenital ureteropelvic junction obstruction, N13.5 Crossing vessel and stricture of ureter without hydronephrosis, and N13.39 Other hydronephrosis will remain unchanged.

Wording Change for Enlarged Prostate

In the original version of ICD-10, the N40.0 and N40.1 codes used the terminology Enlarged prostate (without and with lower urinary tract symptoms, respectively). For ease of searching for the correct code, the codes will be changed to the term more commonly used in the United States: Benign prostatic hyperplasia as follows: N40.0 Benign prostatic hyperplasia without lower urinary tract symptoms, and N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms.

Added More Specific Incontinence Codes

To better define types of incontinence and to increase specificity to the incontinence section, two new incontinence codes will be introduced: N39.491 Coital incontinence and N39.492 Postural (urinary) incontinence.

Added Specific Codes to Prostate Dysplasia

To help better capture types of dysplasia seen on prostate biopsy, the ICD-10 code N42.3 Dysplasia of prostate will be deleted and replaced by more specific codes: N42.30 Unspecified dysplasia of prostate, N42.31 Prostatic intraepithelial neoplasia, N42.32 Atypical small acinar proliferation of prostate, and N42.39 Other dysplasia of prostate.

Added More Specific Testicular Pain Codes: Added Scrotal Pain Code

To improve specificity of testicular pain codes, three codes will be added: N50.811 Right testicular pain, N50.812 Left testicular pain, and N50.819 Testicular pain, unspecified. Because scrotal pain is a condition separate from testicular pain and was not previously captured in the ICD-10, the code N50.82 Scrotal pain will be added.

Added More Specific Postprocedural Erectile Dysfunction Codes

To capture other causes of postprocedural erectile dysfunction that were not included in the original ICD-10, the following codes will be added: N52.35 Erectile dysfunction following radiation therapy, N52.36 Erectile dysfunction following interstitial seed therapy, and N52.37 Erectile dysfunction following prostate ablative therapy. The code N52.39 will be changed to Other and unspecified postprocedural erectile dysfunction, which is a slight wording change.

Added More Specific Dyspareunia Codes

In ICD-10-CM, N94.1 Dyspareunia was a single code. To increase specificity, this code will be deleted and replaced with four more specific codes: N94.10 Unspecified dyspareunia, N94.11 Superficial (introital) dyspareunia, N94.12 Deep dyspareunia, and N94.19 Other specified dyspareunia.

Added Specificity to Urethral Stricture

In the ICD-10, there was no specific code for Fossa navicularis stricture. Therefore, to capture this unique location of a urethral stricture, the code N99.113 will be changed from Postprocedural anterior urethral stricture to N99.113 Postprocedural anterior urethral stricture, and a new code, N99.115 Postprocedural fossa navicularis urethral stricture will be added.

Added Specificity to Stoma Complications

In the ICD-10, the codes in sections N99.52 and N99.53 described hemorrhage, infections, and malfunctions of other external stomas and other stoma of the urinary tract. To improve clarity (incontinence vs continent stoma) and specificity, along with the potential complications of herniation and stenosis, which were not part of the original ICD-10-CM, the codes will changed as follows: N99.520 Hemorrhage of incontinent stoma of urinary tract, N99.521 Infection of incontinent stoma of urinary tract, N99.522 Malfunction of incontinent stoma of urinary tract, N99.523 Herniation of incontinent stoma of urinary tract, N99.524 Stenosis of incontinent stoma of urinary tract, N99.528 Other complication of incontinent stoma of urinary tract, N99.530 Hemorrhage of continent stoma of urinary tract, N99.531 Infection of continent stoma of urinary tract, N99.532 Malfunction of continent stoma of urinary tract, N99.533 Herniation of continent stoma of urinary tract, N99.534 Stenosis of continent stoma of urinary tract, and N99.538 Other complication of continent stoma of urinary tract.

Improved Specificity of Postprocedural Hemorrhage and Hematoma

In the original ICD-10, the codes N99.61 and N99.62 were to be used if there was hemorrhage and/or hematoma of a genitourinary organ complicating a urologic or non-urologic procedure. These complications (hemorrhage and hematoma) will now have their own unique codes as follows: N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure, N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure, N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure, and N99.841 Postprocedural hematoma of a genitourinary system organ or structure following other procedure.

Added Specificity to Other Microscopic Hematuria

In the ICD-10-CM, the code R31.2 Other microscopic hematuria will be deleted and replaced by two more specific codes: R31.21 Asymptomatic microscopic hematuria, and R31.29 Other microscopic hematuria. Note that R31.1 Benign essential microscopic hematuria should be used when patients have familial microscopic hematuria.

Added New Voiding Symptom Codes

To improve specificity of voiding symptoms, three new codes will be added: R39.191 Need to immediately revoid, R39.192 Position dependent micturition, and R39.198 Other difficulties with micturition.

Other New Codes That May Be of Interest to Urologists

Other codes that were added that may be commonly used by urologists include R39.82 Chronic bladder pain, Z53.31 Laparoscopic surgical procedure converted to open procedure, and Z05.6 Observation and evaluation of newborn for suspected genitourinary conditions.

Added Specificity to Abnormal Urine Codes

Code R82.7 Abnormal findings on microbiologic examination of the urine will be eliminated and replaced with the following two codes: R82.71 Bacteriuria, and R82.79 Other abnormal findings on microbiologic examination of the urine.

Added Specificity to Abnormal Radiologic Findings

In ICD-10-CM, the code R93.4 is used for Abnormal radiologic findings on diagnostic imaging of urinary organs. To increase specificity the following codes will be added: R93.421 Abnormal radiologic findings on diagnostic imaging of right kidney, R93.422 Abnormal radiologic findings on diagnostic imaging of left kidney, R93.429 Abnormal radiologic findings on diagnostic imaging of unspecified kidney, and R93.49 Abnormal radiologic findings on diagnostic imaging of other urinary organs.

Added Rising Prostate-specific Antigen Levels After Therapy for Prostate Cancer

To help capture a unique patient status, the code R97.21 Rising PSA following treatment for malignant neoplasm of prostate will be added. The code R97.2 elevated PSA will be eliminated, and Elevated PSA will now be found at R97.20.

Additions and Changes to the Code T83 Section, Complications of Genitourinary Prosthetic Devices, Implants, and Grafts

The number of changes to this code is too large to be listed in this section, so the major changes are summarized here:

• Additions to the Indwelling urethral catheter complications section include the following: T83.0 Mechanical complications of indwelling catheters (T83.01 Mechanical breakdown, T83.02 Displacement, T83.03 Leakage, and T83.09 Other mechanical complications), and T83.51 (Infection and inflammatory reaction) will include more specific types of catheters than had been captured, separating cystostomy catheters from indwelling urethral catheters and nephrostomy catheters.
• The code T83.1 Mechanical complications of other urinary devices will now specify that electronic stimulators of the sacral nerve (sacral nerve modulation) will be found in the T85 section.
• In T83.2 Mechanical complication of graft of urinary origin, codes will be added specifically for erosion and exposure of graft that were not previously captured.
• In sections T83.4 Mechanical complication of other prosthetic devices, implants, and grafts of genital tract, and T83.6 Infection and inflammatory reaction due to prosthetic device, implant, and graft in genital tract, codes for testicular prosthesis will be added.
• In section T83.52 Infection and inflammatory reaction due to prosthetic device, implant, and graft in the urinary system, unique codes for neurostimulator device, implanted sphincter, ureteral stent, and other stents as other prosthetics will be added.
• In section T83.7 Complications due to implanted mesh and other prosthetic materials, unique codes were added to specify T83.611 Erosion of vaginal mesh into vagina, T83.712 Erosion of vaginal mesh into other organs or pelvic floor muscles, and T83.713 Erosion of other mesh (male/female).
• In section T83.8 Other specified complications of genitourinary prosthetic devices, implants, and grafts, the following codes will be eliminated: T83.31 Embolism, T83.83 Hemorrhage, T83.85 Stenosis, and T83.86 Thrombosis, as these are unlikely complications.

Conclusions

On October 1, 2016, there are several new, deleted, and changed from/changed to codes that will affect urologists. Changing documentation appropriately and understanding the changes is important to accurate coding of patients. In future years, there will be other code alterations.