patient is admitted for acute bilateral pyelonephritis. what is the appropriate icd-10-cm code?4

by Destin Douglas 3 min read

ICD-10 code N10 for Acute pyelonephritis is a medical classification as listed by WHO under the range – Diseases of the genitourinary system. How do you code pyelonephritis? N10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

ICD-10 code N10 for Acute pyelonephritis is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .

Full Answer

What is the ICD 10 code for acute pyelonephritis?

RATIONALE: Acute pyelonephritis is coded N10, unless mention of a lesion of renal medullary necrosis is documented. Do not use chronic pyelone-phritis because the documentation clearly states "acute." Look in the ICD-10-CM Alphabetic Index for Pylonephritis/acute N10. Verify code selection in the Tabular List.

Should I use chronic or acute pyelonephritis (N10)?

Do not use chronic pyelone-phritis because the documentation clearly states "acute." Look in the ICD-10-CM Alphabetic Index for Pylonephritis/acute N10.

What is the CPT code for nephrolithiasis?

Rationale: Code 52001 describes a cystourethroscopy with irrigation and evacuation of multiple obstructing clots. In the CPT® Index locate Evacuation/Clots/Endoscopic. Codes 52214, 52400 and 52005 describe various procedures that were not performed. The patient is a very pleasant 72 year-old female noted to have bilateral nephrolithiasis.

What is the CPT code for percutaneous pyelostolithotomy?

Created by yeil07 AAPC Ch 12 Terms in this set (46) 50080 What is the correct CPT® code for a percutaneous pyelostolithotomy with dilation and basket extraction measuring 1 cm? 50500 The urologist is called to the operating room to repair a kidney laceration status post MVA.

What is the DX code for pyelonephritis?

N10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM N10 became effective on October 1, 2021.

What is the ICD 10 code for history of pyelonephritis?

Personal history of other diseases of urinary system The 2022 edition of ICD-10-CM Z87. 448 became effective on October 1, 2021.

What is the ICD-10-CM code for kidney infection?

ICD-10-CM N39. 0 is grouped within Diagnostic Related Group(s) (MS-DRG v39.0): 689 Kidney and urinary tract infections with mcc. 690 Kidney and urinary tract infections without mcc.

What is the ICD 10 code for obstructive pyelonephritis?

ICD-10-CM Code for Chronic obstructive pyelonephritis N11. 1.

What is acute pyelonephritis?

Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidney most often seen in young adult women. History and physical examination are the most useful tools for diagnosis. Most patients have fever, although it may be absent early in the illness.

What is the meaning of pyelonephritis?

Pyelonephritis is a type of urinary tract infection where one or both kidneys become infected. They can be infected by bacteria or a virus. It can cause people to feel very sick and it requires treatment. This article will tell you more about kidney infection and what to do about it.

What is ICD-10 code N12?

N12: Tubulo-interstitial nephritis, not specified as acute or chronic.

What is the ICD-10 code for pyelonephritis in pregnancy?

ICD-10 code O23. 0 for Infections of kidney in pregnancy is a medical classification as listed by WHO under the range - Pregnancy, childbirth and the puerperium .

Can you code UTI and pyelonephritis?

0 Urinary tract infection, site not specified. Use the most specific code(s) when you can – such as N30. 00 and N30. 01 for acute cystitis, or N10 for pyelonephritis.

What is the ICD 10 code for Xanthogranulomatous pyelonephritis?

We can code 590.00 Chronic Pyelonephritis.

What are the symptoms of acute pyelonephritis?

Symptoms & Causes of Kidney Infection (Pyelonephritis)chills.fever.pain in your back, side, or groin.nausea.vomiting.cloudy, dark, bloody, or foul-smelling urine.frequent, painful urination.

What is chronic obstructive pyelonephritis?

Chronic pyelonephritis is characterized by renal inflammation and scarring induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction.

What is the ICd 10 code for kidney stones?

Rationale: ICD-10-CM has a combination code to report when there are stones (calculi) in the kidney and ureter. Look in the ICD-10-CM Alphabetic Index for Calculus, calculi, calculous/kidney/with calculus, ureter which directs you to N20.2. Verify code selection in the Tabular List.

What is the ICd 10 code for enlarged prostate?

In the ICD-10-CM Alphabetic Index look for Enlargement, enlarged/prostate/with lower urinary tract symptoms (LUTS) directing you to code N40.1. In the Tabular List locate N40.1 and you are directed to use additional code for associated symptoms. Code R33.8 is used to describe urinary retention. Verify code selection in the Tabular List.

What is the procedure to fulgurate a ureteral lesion?

The urologist performs a cystourethroscopy with ureteroscopy to fulgurate a ureteral lesion.

What is CPT 52353?

Two procedures are performed. CPT® 52353 describes laser lithotripsy and does not include ESWL. CPT® 52332 describes the stent placement, but does not include the ESWL. CPT® 50590 describes the ESWL but not the placement of the stent. CPT® 50590 and 52332 describe both procedures performed. Modifier LT is appended to 50590 to indicate the lithotripsy was performed on the left kidney. Modifiers 51 and LT are appended to code 52332 to indicate more than one procedure was performed on the left side. Look in the CPT® Index for Lithotripsy/Kidney and Insertion/Stent/Ureteral.

What is the code for removal and replacement of a ureteral stent?

In the CPT® Index look for Removal/Stent/Ureteral for the code range. Code 50384 uses a percutaneous approach for only the removal of the stent; code 50386 is removal only. Code 50385 is for the removal and replacement via a transurethral approach. The code description includes the radiological supervision and interpretation and modifier 26 is not appended.

What is CPT code 51555?

In the CPT® Index look for Cystectomy/Partial/Complicated. The description of code 51555 is Cystectomy, partial; complicated (for example, postradiation, previous surgery, difficult location). Modifier 22 is not appended to the code as it already includes the additional work involved in the procedure.

What is the CPT code for a vesectomy?

In the CPT® Index look for Vasectomy/Reversal refers you to see Vasovasorrhaphy directing you to code 55400. There are two parenthetical instructions beneath the code instructing us to use modifier 50 for a bilateral procedure and to use 69990 when an operating microscope is used.

What is the CPT code for a neobladder?

Rationale: Creation of a neobladder allows the patient the ability to void and is reported with 51596. In CPT® code 51580 an -ostomy is created and urine is emptied into an appliance bag. In CPT® 51590 a catheter is placed and used to remove urine from the body. Look in the CPT® Index for Neobladder/Construction.

What is the ICd 10 code for bladder neoplasm?

In the ICD-10-CM Table of the Neoplasms look for Neoplasm, neoplastic/bladder (urinary)/dome and select the code from the Malignant Primary column which directs you to code C67.1. If the provider documentation does not report the exact location of the tumor, using the unspecified diagnosis code C67.9. Verify code selection in the Tabular List.

What is the procedure to fulgurate a ureteral lesion?

The urologist performs a cystourethroscopy with ureteroscopy to fulgurate a ureteral lesion.

What is the code for cystourethroscopy?

Rationale: Code 52001 describes a cystourethroscopy with irrigation and evacuation of multiple obstructing clots. In the CPT® Index locate Evacuation/Clots/Endoscopic. Codes 52214, 52400 and 52005 describe various procedures that were not performed.

What is the CPT code for a sphincter?

Rationale: In the CPT® Index look for Insertion/Prosthesis/Urethral Sphincter. You're directed to 53444-53445. Codes 53446-53448 are for the removal or removal/replacement of the inflatable sphincter. CPT® 53445 describes the insertion of an inflatable urethra/bladder neck sphincter, including placement of pump, reservoir and cuff.

What is CPT 53660?

Rationale: In the CPT® Index look for Urethra/Dilation/Suppository and/or Instillation. CPT® 53660 is for the initial dilation. CPT® 53605 and 53665 are reported when general or spinal anesthesia is provided. No type of anesthesia is indicated in the note. This is a repeat procedure and the subsequent CPT® code 53661 is reported.

What is the ICd 10 index for ureter?

Look for Sclerosis, sclerotic/renal directing you to N26.9. To find inflammation of the ureter. Next look for Ureteritis directing you to N28.89

Why do they put a Foley catheter in the ED?

The provider decides to place a Foley catheter to relieve the urine retention due to prostate hypertrophy. What is the code selection for the procedure and diagnosis codes?

What is a bugbee biopsy?

Bugbee was used to fulgurate the biopsy sites to diminish bleeding. Cystoscope was replaced with the cystoscope designed for the GreenLight laser. We introduced this into the patient's urethra and performed GreenLight laser ablation of the prostate down to the level of verumontanum on, the prostatic crest near the wall of the urethra. There were some calcifications at the left apex of the prostate, causing damage to the laser but adequate vaporization was achieved. What CPT® code(s) is/are reported for this service?

What was done to mobilize the ureter and to identify the area of the stone impaction by palpation?

Careful dissection was done to mobilize the ureter and to identify the area of the stone impaction by palpation.

What is the statement of operation for a lithotomy?

Statement of Operation: The patient was brought to the operating room and placed on the operating table in the supine position. After adequate general endotracheal anesthesia was accomplished, he was put in the dorsal lithotomy position and was prepped and draped in the usual sterile fashion. A 20 French Foley catheter was introduced in the patient's urethra, and the balloon was inflated with 20ml of sterile water.

What is the procedure for a ureteral catheter?

The urologist is asked by the general surgeon to place ureteral catheters for visualization of ureters during a complicated bowel surgery. Cystoscopy is performed and ureteral catheters are inserted. The general surgeon removes the catheters at the end of the case. Code the procedure.

What is the code for acute pyelonephritis?

RATIONALE: Acute pyelonephritis is coded N10, unless mention of a lesion of renal medullary necrosis is documented. Do not use chronic pyelone-phritis because the documentation clearly states "acute." Look in the ICD-10-CM Alphabetic Index for Pylonephritis/acute N10. Verify code selection in the Tabular List.

What is the CPT code for bladder tumor removal?

RATIONALE: Look in the CPT® Index for Fulguration/Cystourethroscopy with/Tumor. You are referred to 52234-52235, 52240, 52250. When different size bladder tumors are removed in one surgical session, the code selection is based on the largest tumor size. In this example, the largest tumor removed is 3.0 cm. Only one code is reported regardless of the number of tumors removed.

What is the CPT code for a hernia repair?

RATIONALE: Umbilical hernia repair codes are reported using CPT® 49580-49587 and are differentiated by the age of the patient and whether or not the hernia is reducible, incarcerated or strangulated. A reducible hernia is one that can be reduced to a normal position. An incarcerated or strangulated hernia is one that cannot be reduced to a normal position without surgical intervention. The description of CPT® 51500 Excision of urachal cyst or sinus, with or without umbilical hernia repair includes the umbilical hernia repair. Hernia repair is not reported separately; therefore, CPT® 51500 is the correct answer. Look in the CPT® Index for Cyst/Urachal/Bladder/Excision 51500.

Why is CPT 11621 not reported?

CPT® 11621 describes a malignant lesion excision and is not reported because there is no documentation of a malignant lesion excision. Tip: When determining the specific code to report, the body system or organ should be accessed first, before using the integumentary codes.

What was instilled in the urethra of a swollen bladder?

The bladder was emptied, and lidocaine jelly was instilled in the urethra. He was extubated and taken to the recovery room in good condition.

What position was the patient placed in the operating room table?

Procedure description: The patient was placed on the operating room table in the supine position, and general anesthesia was induced. He was then placed in the lithotomy position and prepped and draped appropriately.

What is a post operative diagnosis?

Postoperative diagnosis: Bladder/Prostate tumor. (This is the diagnosis if no other positive findings are found in the operative note. In this case, the post-operative diagnosis is different from the pre-operative and has incorporated findings from the operative session and ultimately the pathology report.)