Published on February 24, 2020
slide 1: Documenting and Coding Ureteral Obstruction Ureteral obstructions are blockages that occur in your urinary tract. The article gives a detailed overview of the condition along with the associated medical codes. Outsource Strategies International United States slide 2: www.outsourcestrategies.com 918-221-7769 Ureteral obstructions are fairly common blockages that occur in one or both of your ureters. The ureters are two tubes that carry urine from each of your kidneys to your bladder. An obstruction in the ureters prevents urine from moving into your bladder and out of your body. Obstructions or blockages in the ureters can be either complete or partial. If left untreated urine can back up and damage your kidneys causing symptoms like pain fever and infections. In severe cases a ureteral obstruction can lead to kidney failure sepsis life-threatening infection or even death. Treatment for this condition includes measures to open up a blocked path and to treat the cause of the blockage. Treatment modalities consist of drainage procedures to remove urine from your body and temporarily relieve the problems caused by a blockage. In addition antibiotics may also be prescribed to clear the associated infections. Correctly diagnosing and documenting the obstructions within the ureters can be a complex task for physicians. Clear and precise medical record documentation is essential for correct billing and coding for this urology condition. With proper documentation medical billing companies can help physicians select the correct medical codes and file claims for maximum reimbursement. According to reports the prevalence of urinary tract obstruction ranges from five in 10000 to five in 1000 depending on the cause. An obstruction may occur suddenly or develop slowly over days weeks or even months. It can either completely or partially block part of the urinary tract. In some cases only one kidney is affected but obstruction may affect both the kidneys. The condition is quite common in men particularly as they age their prostate gland tends to slide 3: www.outsourcestrategies.com 918-221-7769 enlarge a condition called benign prostatic hyperplasia and block the flow of urine. However in children the obstruction is mainly due to birth defects affecting the urinary tract. Causes and Symptoms There are different types of ureteral obstructions each having specific causes and some of them present at birth congenital which include - duplication of the ureter severe constipation retroperitoneal fibrosis ureteral stones internal tissue growth long-term swelling of the ureter wall and cancerous and noncancerous tumors. The condition may not depict any specific signs or symptoms. In fact the type and severity of symptoms depend on where the obstruction occurs type of obstruction whether its partial or complete how quickly it develops and whether it affects one or both kidneys. Common symptoms include - Abdominal pain on one or both sides called flank pain Repeated urinary tract infections Leg swelling High blood pressure hypertension Fever Difficulty urinating Changes in the amount of urine produced Blood in the urine called hematuria Reduced urine output called oliguria How to Diagnose and Treat Ureteral Obstruction slide 4: www.outsourcestrategies.com 918-221-7769 Patients experiencing any of the above symptoms must consult a urologist. Urologists may enquire about the symptoms and perform a physical examination on that basis. Urine and blood tests may be conducted to check for signs of infection which may suggest that the kidneys are not working well. Imaging tests like MRI scan CT scan Voiding cystourethrogram Renal nuclear scan Cystoscopy and Ultrasound may be performed to find the location and cause of the blockage. Other additional tests may be recommended based on the results of these tests. Treatment will involve surgery to remove or if possible bypass blockages and repair any damage to the ureters and kidneys. Antibiotics may be prescribed to clear associated infections. For ureteral obstruction that causes severe pain the urologist may perform an immediate procedure to remove urine from the body and temporarily relieve the problems caused by a blockage. In such cases aurologist may recommend - a ureteral stent a hollow tube inserted inside the ureter to keep it open Percutaneous nephrostomy a tube inserted through your back to drain the kidney and a catheter a tube inserted through the urethra to connect the bladder to an external drainage bag. Based on the type and severity of the condition the urologist may recommend either a single procedure or a combination of procedures which best suits the patient’s condition. However drainage procedures may at times provide temporary or permanent relief depending on the severity of the condition. If any of these procedures don’t give the desired result surgery may be performed to correct ureteral obstructions. The type of surgical slide 5: www.outsourcestrategies.com 918-221-7769 procedure may depend on the patient’s condition and may include - Endoscopic surgery Laparoscopic surgery or open surgery. The number and size of incisions used for the procedure and recovery period determine the main differences between each of these surgical options. Based on the patient’s symptoms and condition the urologist may decide on the type of procedure and the best surgical approach to treat the condition. Urology medical billing and coding involves using the specific ICD- 10 diagnosis codes and CPT codes to report various urinary tract disorders like ureteral obstruction and the treatments provided on the medical claims that providers submit to health insurers. Urologists or other specialists who treat patients need to submit correct documentation that meets payer guidelines. In addition to medical billing and coding services insurance verification and pre-authorization services are essential to verify the patient’s coverage. ICD-10 Codes N13.0 - Hydronephrosis with ureteropelvic junction obstruction N13.1 - Hydronephrosis with ureteral stricture not elsewhere classified N13.2 - Hydronephrosis with renal and ureteral calculous obstruction CPT Codes 52005 - Cystourethroscopy with ureteral catheterization with or without irrigation instillation or ureteropyelography exclusive of radiologic service slide 6: www.outsourcestrategies.com 918-221-7769 52310 - Cystourethroscopy with removal of foreign body calculus or ureteral stent from urethra or bladder separate procedure simple 52315 - Cystourethroscopy with removal of foreign body calculus or ureteral stent from urethra or bladder separate procedure complicated 52332 - Cystourethroscopy with insertion of indwelling ureteral stent eg Gibbons or double-J type 52352 - Cystourethroscopy with ureteroscopy and/or pyeloscopy with removal or manipulation of calculus ureteral catheterization is included 52353 - Cystourethroscopy with ureteroscopy and/or pyeloscopy with lithotripsy ureteral catheterization is included 52356 - Cystourethroscopy with ureteroscopy and/or pyeloscopy with lithotripsy including insertion of indwelling ureteral stent eg Gibbons or double-J type 50382 - Removal via snare/capture and replacement of internally dwelling ureteral stent via percutaneous approach including radiological supervision and interpretation 50384 - Removal via snare/capture of internally dwelling ureteral stent via percutaneous approach including radiological supervision and interpretation 50385 - Removal via snare/capture and replacement of internally dwelling ureteral stent via transurethral approach without use of cystoscopy including radiological supervision and interpretation slide 7: www.outsourcestrategies.com 918-221-7769 50386 - Removal via snare/capture of internally dwelling ureteral stent via transurethral approach without use of cystoscopy including radiological supervision and interpretation 50387 - Removal and replacement of externally accessible nephroureteral catheter eg external/internal stent requiring fluoroscopic guidance including radiological supervision and interpretation 50389 - Removal of nephrostomy tube requiring fluoroscopic guidance eg with concurrent indwelling ureteral stent 50433 - Placement of nephroureteral catheter percutaneous including diagnostic nephrostogram and/or ureterogram when performed imaging guidance eg ultrasound and/or fluoroscopy and all associated radiological supervision and interpretation new access 50688 - Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit 50693 - Placement of ureteral stent percutaneous including diagnostic nephrostogram and/or ureterogram when performed imaging guidance eg ultrasound and/or fluoroscopy and all associated radiological supervision and interpretation pre- existing nephrostomy tract 50694 - Placement of ureteral stent percutaneous including diagnostic nephrostogram and/or ureterogram when performed imaging guidance eg ultrasound and/or fluoroscopy and all associated radiological supervision and interpretation new access without separate nephrostomy catheter slide 8: www.outsourcestrategies.com 918-221-7769 50695 - Placement of ureteral stent percutaneous including diagnostic nephrostogram and/or ureterogram when performed imaging guidance eg ultrasound and/or fluoroscopy and all associated radiological supervision and interpretation new access with separate nephrostomy catheter The outlook for ureteral obstruction depends on whether the kidneys were damaged while the urine couldn’t be drained. There is no way to prevent ureteral obstruction caused by – a genetic condition tumor vascular disease or enlarged prostrate. Patients need to increase their intake of water and reduce the intake of sodium salt to prevent development of ureteral stone. Billing and coding for urological conditions can be complex. For correct and appropriate medical billing and claims submission healthcare practices can outsource their medical coding tasks to a reliable medical billing service provider that provides the services of AAPC- certified coding specialists.