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September 4 , 2007

Coding for Kidney Stones

For the Record
Vol. 19 No. 18 P. 30

Kidney stones are caused by an excess of calcium, oxalate, and uric acid in
the urine. These stones may occur anywhere within the urinary tract and
are due to overexcretion of salt or reduced excretion of urine. The ICD-9-
CM code assignment for kidney stones is 592.0. Other terms listed under
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code 592.0 include the following:

Calculus of kidney;

Nephrolithiasis, not otherwise specied;

Renal calculus;

Renal stone;

Staghorn calculus; and

Stone in kidney.

A kidney stone associated with gout is classied to code 274.11, Uric acid nephrolithiasis. ICD-
9-CM assumes the kidney stone is acquired. If it is a congenital kidney stone, then assign code
753.3. Kidney stones may be common in premature infants. The following are code
assignments for stones located in other parts of the urinary tract:

Bladder 594.1;

Diverticulum of bladder 594.0;

Ureter/ureteropelvic junction 592.1;

Urethra 594.2;

Other lower urinary tract 594.8;

Unspecied part of lower urinary tract 594.9; and

Unspecied site of urinary system 592.9.

Kidney stones vary in size from a staghorn calculus that may ll the entire renal pelvis and
calices to microscopic crystalline foci.

Symptoms
Some kidney stones may be asymptomatic. However, when symptoms are present, it is often
described as the worst pain ever experienced. A patient with kidney stones may present with
ank pain on one or both sides, back pain, nausea and vomiting, urinary frequency, painful
urination, abdominal pain, chills, and/or fever.

Hematuria, or blood in the urine, is also a common symptom of kidney stones. However, since
hematuria is usual with kidney stones, it should not be assigned as a secondary diagnosis. It is
For The Record
considered an integral part of the condition, and therefore, according to coding guidelines,
cannot be assigned as a secondary diagnosis (AHA Coding Clinic for ICD-9-CM, 1995, third Sukai Halaman
quarter, page 8 and 2006, fourth quarter, page 149).

Complications For The Record

The following are complications associated with kidney stones. If present and treated during magazine
the hospital stay, they may be coded as a secondary diagnosis: 10 jam yang lalu

Check out the October issue for

Hypercalcemia/hypercalcinuria 275.40;
info on avoiding burnout,
Hydronephrosis (591) often an indicator of an obstructing stone; cutting down on copy and
paste, and preparing for
Secondary hypertension (405.x9); cyberattacks like the NotPetya
virus.
Obstructive uropathy 599.60;

Pyelonephritis (590.xx); or
En
Urinary tract infection (599.0) when stones block the ow of urine, bacteria becomes
trapped thereby causing an infection.

Diagnosis
Some diagnostic tests that detect the presence of kidney stones include abdominal x-rays,
 intravenous pyelogram, kidney ultrasound, retrograde pyelogram, abdominal CT scan, and
abdominal/kidney MRI.

Urinalysis may show hematuria and an increased white blood cell count (pyuria), which may
indicate an infection in the kidneys or throughout the body.

Treatment
Kidney stone treatment depends on the stone type and size. The stone may pass
spontaneously. However, if intervention is taken, extracorporeal shock wave lithotripsy (ESWL)
is the most common procedure. ESWL (98.51) uses shock waves to fragment the stone. The
small pieces then pass in the urine. Code 98.51 includes removal of calculus by shock waves
from any area in the urinary system (eg, kidney, bladder, renal pelvis, ureter). Other procedures
for the removal of calculus include the following:

Lithotripsy of kidney 56.0;

Lithotripsy of bladder 57.0;

Lithotripsy of urinary bladder with ultrasonic fragmentation 57.0 + 59.95 AHA Coding Clinic
for ICD-9-CM, 1996, rst quarter, pages 10-11);

Basket extraction of stone via transurethral approach (without incision) 56.0 (AHA Coding
Clinic for ICD-9-CM, 1994, fth issue, page 5 and 1989, rst quarter, pages 1-3);

Basket extraction of stone via percutaneous lithotripsy 55.03;

Transurethral ureteroscopic lithotripsy using laser to fragment the stone 56.0 (AHA Coding
Clinic for ICD-9-CM, 1989, rst quarter, page 1);

Cystolithotomy 57.19;

Percutaneous nephrostomy without fragmentation 55.03;

Percutaneous nephrostomy with fragmentation (eg, ultrasound) 55.04; and

Removal of kidney stone by nephrotomy 55.01.

Once a patient has had a kidney stone, the chance of recurrence is likely.

Coding and sequencing for kidney stones are dependent on the physician documentation in the
medical record and application of the Ofcial Coding Guidelines for inpatient care. Also, use
specic AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant
references to ensure complete and accurate coding.

This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M

Consulting Services is a business of 3M Health Information Systems, a supplier of coding and
classication systems to nearly 5,000 healthcare providers. The company and its representatives
do not assume any responsibility for reimbursement decisions or claims denials made by
providers or payers as the result of the misuse of this coding information. More information
about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-
2447.

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