Hello today we're going to talk about chapter 21 the diseases of the genitourinary system
and this corresponds to chapter 14 in the codebook.
The term urinary tract infection is used to cover many things and I have listed here the
three things you'll see most commonly referred to as a urinary tract infection.
The codes for UTI's in that some include the name of the organism and some do not so when
there is no subterm for that organism that causes that infection we have to code the
condition and then have an additional code from the categories B95-B97 we're going to
look at three exercises that look at different ways you would code a urinary tract infection
or anything that has to do with the urinary system that has the infected organisim as
part of the diganostic statement the first one Exercise 21.1 number 1 is the urethral
stricture due to the gonorrheal infection and here's an example where you do have the
code including the infecting organism and here's your pathway and I have just a word
of caution there to be careful when you're choosing your subterms ureter and urethra
and urinary you really have to be careful what you're reading those terms correctly
and there's many indentations levels under these terms because it is such a large system
so be sure that you're following your indentation carefully
Exercise 21.1 number 2 you havd the group B strep but it is not included in your code
discription.
So you pretty easily find the abscess of the scrotum and then when you start looking for
that additional code you're going to start with that main code streptococcus in this
case and notice that you can code to just streptococcus or more specifically streptococcus
group B so be sure you're following that carefully and this one number three is a bit more challenging
in that you cannot find the main term helicobactor you would have to start with infection so
you'll just learn as a coder the different ways that you're going to find codes sometimes
it's not as explicit as it is other times but you can remember that when you're coding
that additional code when you have an infection no matter which body system you're talking
about it's in the B95 thru B37 category so if you're finding a code that say is an A
code you know that's not right because you know it needs to be in that B95 thru B87 category
to be cause of an infection classified elsewhere This exercise number 5 I've included because
of the different ways you have to find the monilia, monilia and candidiasis are used
interchangably you'll see both in the literture or in the medical record and I would reccommend
you look at the B37 category and look up all the different infections infections in the
body that can be caused by candidiasis for women it's very common to have a yeast infection
a vaginal yeast infection but you can have yeast infections anywhere on the body so that's
why that B37 category might be a good one for you to look at
I have the pathway here on the right that you can find how I eventually got to this
code there's a lot of steps involved when it's not very explcit which way you're going
to start so you just start looking and if all of your see also or see this or see that
until you finally get to the code that you need and here is an example of a urinary tract
infection due to the candidasis and you actually it refers you to candidasis when you go there
though you find that there is no subterm for urinary tract infection the closest is the
urogenital site so that's the code that I choose
hematuria is something that is integral to any unrirany tract infection sometimes the
blood is micrcoscopic meaning you can only see it with a mircoscope some times you can
see it with the naked eye and that's when it's called a gross hematuria like if the
urine is red it's so bloody if the provider is documenting that the hematuria is excessive
then you would code the gross humaturia but otherwise you just know that hematuria is
integral to any unrirnay tract infection and you do not code it urinary incontinence is
something that can occur in both male and female patients you see it in women primarly
because of childbearing and in men following prostrate surgery urge incontinence is just
when you can't hold it's very common with aging as well and a patient could have a mix
could have a mix of the stress and urge incontinence as well you can also have urinary incontinence
due to cognitive impairment physical mobilities or immobilities that is an R code not an N
code you can have urinary incontinence of nonorganic meaning it's more of a mental health
or behavioral issue that is an F code F98 enuresis not due to a substance or known physicological
condition but no matter what is causing your incontinence if you know what that underlying
cause is that is coded first and then your urinary incontinence code chronic kidney disease
we've looked at it in a couple of body systems it's important to remember that that develops
as a complication of other diseases and your coding handbook mentions the diseases that
are here on the slide and how you sequence those codes is going to be based on your instructional
notes and your excludes one and excludes two notes in the Tabular once you've found your
notes Stages of CKD are based upon the glomerular
filtration rate I have here the components of that calculation how the doctor comes up
with but basically what happens as your kidney disease gets worse your glomerular filtration
rate number goes down so that is how the stages stage 5 is worse than stage 1 for example
When you get to end stage renal disease it's important to remember that is the last stage
the last stange and the patient either has to go on dialysis or recieve a kidney transplant
to continue to live if a patient is getting end stage renal disease and disalysis you
must remember to add that Z99.2 code anytime you report that and this last bullet point
you might see in the medical record that if a doctor has documented that a patient is
stage five but is requiring chronic dialysis the coder is not going to code stage five
but the coder is going to immediately go in and code the end stage renal disease N18.6
and the dialysis Z99.2 following the instructional notes that exludes 1 note at code N18.5 so
there are times when a coder can make a decision that isn't based on the providers documentation
and this is one of those times I've added a few slides about hemodialysis because unless
you've known someone whose been on dialysis or worked in the field you may not realize
all that goes into that hemodialysis hemo is blood the blood is allowed a few ounces
at a time through this filter and then it is returned back to the body and a patient
typically has to go to a dialysis center three times a week three to five hours or more hours
each visit it's very time consuming and life alterning for someone to have to be on hemodialysis
the rest of their lives when a patient is going to be recieving hemodialysis an AV or
an arterial venious fistula is created by a surgeon because you need a very strong vessel
that's going to be stuck repeatdly each time they have dialysis there's going to be needles
inserted in these veins so unless you have really made a stronger than normal vein it's
not going to withstand all those sticks it typically require two to three months for
that fistula to develop a patient may have to wait until that fistula is developed before
than can actually start the dialysis so it's something that it has to it's just part of
to have to get the fistula and it's probably not something thats comfortable for someone
who has to undergo dialysis heres an image I found on google images that shows that that
thee dialysis nurse would have two needles inserted into the patient into that vein one
is carrying blood from the body to the dialyzer and the other one is carrying the filtered
blood back to the body in peritoneal dialysis you've got this cleaning fluid that flows
through a tube into a patients abdomen and then pulls it back out once it's been filtered
many times patients can do this at home it doesn't require hours at a dialysis center
but there's lots of reasons why a doctor might say the patient has to have hemodialysis or
has to have peritoneal dialysis it's the physicians decision which one works best for this any
particular patient I wanted to just remind you about google images while I'm thinking
of it anytime you want to see something wether it's a disease process or a medical procedure
if you go to google image you're going to find hundreds of them you can just scroll
through them I'm a visual learner anytime I see a picture like this or any other one
it helps me remember something about that process or that procedure or the body system
so I encourage you to take advantage of google image just to kind of help you with your learning
process and here is an exercise that has to deal with that AV fistula this one calls for
stenosis and I choose this one to show you because I had a little bit of difficultly
figuring out how they coded it they have gone I realize it's a complication of a procedure
so I started with complication but the only thing that came close to giving me the right
code was the cather and I found that primarly by looking up the subterm dialysis so another
example of how you really have to get very familiar with your codebook and reading above
and below any given main term to be sure that you have choosen the most specfic code you
could find to describe a given situation and here's another example that talks about end
stage dialysis sorry end stage renal disease with hypertension and the dialysis status
and you notice that that stage five chronic kidney disease the hypertension because of
that is the first code that is an assumed relationship between hypertension and end
stage renal disease you find that there are two different ways there on the right that
you could get to that I12.0 but be sure that you include the end stage renal disease and
the dialysis as additonal codes now lets talk for a bit about BPH benign prostatic hyperplasia
you may also see it called benign prostatic hypertrophy either way it is an enlargement
of the prostate gland the prostate is typically just a walnut sized gland very small but the
urthera goes right through it and so when that prostate glad gets larger the urthera
is compressed like you see here on the right in this image and it causes all kinds of urinary
lower tract problems for gentlemen with this problem when you're coding BPH you're going
to see it without LUTS or lower urinary tract infections that's in N40.0 or with LUTS in
40.1 there is an instructional note under the N40.1 code that says use additonal code
for any of these symptoms and these all are taken right out of the book to show you all
the things that might happen it's very uncommon for someone who has enlarged prostate to not
have this lower urinary tract symptoms in fact I've never coded someone who didn't have
them but I guess if it was early enough in the process they may not have all the problems
that they can have now but these prostates can get as large as a grapefruit size which
I can't even imagine how uncomfortable that would be but that's why you get all those
problems because it's compressing the urethra and here's an example of benign prostatic
hypertrophy with urinary tract symptoms and we follow our instructional note to use addiontional
code with a urinary obstruction after all our powerpoints remember that I'm only doing
some of the questions and some of the guidelines any exam questions can relate to some the
guidelines and be sure you follow your assignment schedule please post any questions in the
dicussion board quoting from me the path that you used to try to answer questions and I
like when you do that because that way all of us can look at the discussion and the conversation
back and forth that way we call all continue to learn thank you have a good weekend