Prepare for ICD-10 Codes Effect

Each year, there are millions of people suffering from kidney ailments. As those numbers are on the rise, the diagnosis code for this code will still rank among your commonly used codes when ICD-10 becomes effective in 2013.

Good tidings: You will almost find a one-to-one code correspondence between ICD-9 2011 and ICD-10 2011for "calculus of kidney and ureter" codes.

The key difference is that ICD-10 offers a code (N20.2) that is proper when the patient has calculi of both the kidney and the ureter. Under ICD-9, you would report the same diagnosis using two codes (592.0 and 592.1).

Instructional news: The 'includes' notes for these codes are almost identical for ICD-9 and ICD-10. Take special care in reviewing the 'excludes' notes, though, as ICD-10 has two different types of excludes notes that have two different meanings.

According to ICD-9 guidelines, an 'excludes' note shows terms that you should code elsewhere. The guidelines state that the term excludes means 'do not code here'. For instance, an ICD-9 excludes note guides you to assign 275.49 for nephrocalcinosis rather than using a code in the 592 range (Calculus of kidney and ureter).

In comparison, ICD-10 has both "Excludes1" and "Excludes2" notes. As per ICD-10 guidelines, Excludes 1 means 'NOT CODED HERE.' As a matter of fact, you should never report the excluded code at the same time as the code above the Excludes 1 note. Excludes 1 means the 'two conditions cannot take place together'.

Instead, an Excludes2 note tells you that the excluded term should be reported using another code. However if the patient has both conditions you may report both codes. In other words, when an Excludes2 note appears under a code it's acceptable to use both the code as well as the excluded code together.

An instance of Excludes1: ICD-10 lists an Excludes1 note directly under N20 (Calculus of kidney and ureter). This means the note applies to the entire N20 range. The excluded terms are "nephrocalcinosis" (E83.5-, Disorders of calcium metabolism) and "that with hydronephrosis" (N13.2, Hydronephrosis with renal and ureteral calculous obstruction).

As these terms are listed as an Excludes1 note, you should never report N20 - with N13.2 or the code for nephrocalcinosis (E83.5).

Excludes2example: Code N21.0 (Calculus in bladder) has an Excludes2 note for staghorn calculus indicating you should report N20.0 in place of N21.0 for that diagnosis. However because this is an Excludes2 note, if the documentation shows both "staghorncalculus" (N20.0) and "calculus in bladder" (N21.0), you may use the codes for each on the same claim.

Remember: When ICD-10 goes into effect, you should apply the codes and official guidelines in effect at that time. Learn more at a one-stop medical coding guide like Supercoder.