On October 1, 2015, the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) replaced the ICD-9 for documenting the indication for medical encounters in the United States. A moratorium on changes (additions, deletions, or changes) to the coding system was placed for 1 year after initial implementation, with new and updated codes released yearly on October 1st. The first update took place on October 1, 2016, and a further update will take place on October 1, 2017. The updated and new codes that may be of interest to urologists are described here, limited mostly to an update in undescended testicle codes.
When treating patients with cryptorchidism, it is important to determine the presence or absence of a testicle, and, if present, the location of the testicle. More specifically, it is important to document the possible locations of an undescended or ectopic testicle: intra-abdominal, inguinal canal, high scrotal, or ectopic. The current code set includes unique codes for abdominal, ectopic, and ectopic perineal testicles, and codes for whether the condition is unilateral or bilateral, comprising 10 unique billable codes.
Current ICD-10 Codes for the Q53 (Undescended and Ectopic Testicle) Set:
Q53.0: Ectopic testis (not billable)
Q53.00: . . . unspecified
Q53.01: . . . unilateral
Q53.0: Ectopic testes, bilateral
Q53.1: Undescended testis, unilateral (not billable)
Q53.10: Unspecified undescended testicle, unilateral
Q53.11: Abdominal testis, unilateral
Q53.12: Ectopic perineal testis, unilateral
Q53.2: Undescended testicle, bilateral (not billable)
Q53.20: Undescended testicle, unspecified, bilateral
Q53.21: Abdominal testis, bilateral
Q53.22: Ectopic perineal testis, bilateral
Q53.9: Undescended testicle, unspecified
However, the current ICD-10 coding is insufficient, as it lacks specific codes for inguinal undescended testicle, high scrotal undescended testicle, and nonpalpable testicle. In addition, inguinal undescended testicle is mapped to the “abdominal” code. The updated code set has addressed these deficiencies. The new codes (shown in italics) include differentiation between intra-abdominal and inguinal testicles, add high scrotal testicle codes, and create new codes (in the “R” section) for patients with nonpalpable testicles.
ICD-10 Codes for the Undescended and Ectopic Testicle and Nonpalpable Testicle Set Starting October 1, 2017:
Q53.02: Ectopic testes, bilateral
Q53.1: Undescended testicle, unilateral (not billable)
Q53.11: Abdominal testis, unilateral (not billable)
Q53.111: Intra-abdominal unilateral testis
Q53.112: Inguinal unilateral testis
Q53.13: High scrotal testis, unilateral
Q53.21: Abdominal testis, bilateral (not billable)
Q53.211: Intra-abdominal bilateral testis
Q53.212: Inguinal bilateral testis
Q53.23: High scrotal testis, unilateral
R39: Other and unspecified symptoms and signs involving the genitourinary system
R39.8: Other symptoms and signs involving the genitourinary system
R39.83: Nonpalpable testicle, unilateral
R39.84: Nonpalpable testicle, bilateral
Occasionally, a patient presents with postoperative intestinal obstruction after urologic surgery. Although these codes do not fall into the typical urologic code set, it is important to be properly able to code the status of an individual patient. In ICD-10, postprocedural intestinal obstruction was captured in one code (K91.3), but this was not specific for whether the obstruction was partial or complete. Starting on October 1, 2017, the K91.3 section will consist of three unique codes:
K91.30: Postprocedural intestinal obstruction, unspecified
K91.31: Postprocedural intestinal obstruction, partial
K91.32: Postprocedural intestinal obstruction, complete
Urologists care for a variety of patients. As payments are increasingly being tied to outcomes and quality, we must continue to engage our patients in their own health. An important aspect of overall health is proper weight and exercise. The new ICD-10-CM code Z71.82 for exercise counseling can be used when the situation arises.
There are hundreds of new, deleted, and revised codes in the ICD-10-CM code set update that will take place on October 1, 2017. It is important that all providers be aware of the specific changes that will affect their individual practices. Although the changes that affect a urologist are somewhat limited this year, be on the lookout for new urethral stricture codes, abnormal urologic imaging codes, and unspecified testicular neoplasm codes in October 1, 2018.
