Coding for Interstitial Cystitis: Alleviate the Misery

coding for interstitial cystitis
Interstitial cystitis (IC) is a chronic inflammation of the bladder wall.
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** This article was reviewed and updated on January 7, 2024. **

coding for interstitial cystitis

Interstitial cystitis primarily affects women, but did you know it can also affect men? This article explores relevant facts about this chronic inflammatory condition, including its diagnosis and treatment. We also dive into coding for interstitial cystitis in ICD-10-CM and its common treatments and drug injections in CPT and HCPCS.

What is Interstitial Cystitis?

Interstitial cystitis (IC), otherwise known as painful bladder syndrome (PBS) or bladder pain syndrome (BPS), is a chronic bladder problem that can be tricky to diagnose. Although the definition of IC has changed over the years, UpToDate provides the American Urological Association’s current definition as “an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks’ duration, in the absence of infection of other identifiable causes.”

How Common is Interstitial Cystitis?

Interstitial cystitis is quite common. In fact, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), IC may affect 3 to 8 million women and 3 to 6 million men in the U.S. 

Symptoms

Interstitial cystitis symptoms can vary from person to person and can change in the same individual over time. Some IC cases are milder than others, with some milder cases causing no disruption to their lives. Conversely, some more severe cases may have symptoms that come and go and result in significant disturbance.  According to the Urology Care Foundation, other problems may coexist with IC, such as irritable bowel syndrome or fibromyalgia. 

Symptoms of IC may include some or all of these:

  • Pain or discomfort. This may get worse as the bladder fills up. In women, the pain or discomfort occurs in the bladder, lower back, lower abdominal, urethral, vaginal, or rectal areas. Interstitial cystitis is often associated with the menstrual period and sexual intercourse. In men with IC, pain may be felt in the testicular, scrotal, and perineal area and with ejaculation.   
  • Urinary frequency. According to the Office on Women’s Health, patients may experience frequency during the day, night, or both, and in severe cases, up to 40 times a day. The frequency may be the only symptom in early or mild cases of IC.
  • Urinary urgency. Patients may feel the need to urinate immediately. Pain, pressure, or spasms may also be experienced with urgency.

Causes of IC/BPS

The cause of interstitial cystitis/bladder pain syndrome is unknown, but researchers believe one or more events may lead to the condition. Many researchers believe a trigger may initially damage the bladder or bladder lining and eventually cause IC to develop. Some of these triggers are:

  • Bladder trauma (such as from pelvic surgery)
  • Bladder overdistention (possibly due to long periods without being able to access a toilet)
  • Pelvic floor muscle dysfunction
  • Autoimmune disorder
  • Bacterial infection (cystitis)
  • Primary neurogenic inflammation (hypersensitivity or inflammation of pelvic nerves)
  • Spinal cord trauma

Once damage occurs to the bladder wall, potassium or other particles can leak into the bladder lining. This may further damage the bladder and cause chronic nerve pain.

Making a Diagnosis

There is no one test to diagnose interstitial cystitis since the symptoms of IC are similar to those of other bladder disorders. However, physicians, usually urologists or gynecologists, can perform tests to rule out other possible diagnoses, such as urinary tract cancer and bladder cancer in both men and women and chronic prostatitis or chronic pelvic pain syndrome in men. The diagnosis of IC is made based on the presence of bladder-related pain, often in combination with frequency and urgency, and the absence of other conditions that could lead to the patient’s symptoms.

History, Exam, and Baseline Pain and Voiding Tests

According to the Urology Care Foundation, a physician may diagnose IC by taking a medical history and examination. In women, the physician will examine the abdomen, pelvis, and rectum. In men, the abdomen, prostate, and rectum will be examined. Because mental health and/or anxiety problems can affect IC, a neurological exam will be done on all patients. Finally, baseline voiding and pain tests will be performed to determine what affects the pain level and how often the patient urinates, which may suggest a different diagnosis.

Other Tests

The physician may also order the following tests:

  • Urine test. The physician will order a urine sample to determine if organisms, germs, pus, or white blood cells are present. If so, there could be an infection, and antibiotics are needed. If the symptoms continue for weeks or months and there is no sign of infection, IC should be suspected.
  • Urodynamic tests. Two small catheters are inserted into the bladder, and the body is filled with water and then drained. This is done to determine how the lower urinary tract is functioning. Urodynamics can be quite painful for IC patients.
  • Cystoscopy. A cystoscope, a thin tube with an optical piece on the end, may be used to look inside the bladder. The cystoscope is placed in the bladder through the urethra to rule out other problems, such as bladder cancer, and if ulcers and IC symptoms are present, IC is a pretty definite diagnosis. If a cystoscopy is done in an operating room, any bladder tumors, stones, bleeding, or ulcers that are seen can be taken care of immediately. This involves the physician taking a tissue sample, called a biopsy, to help in the diagnosis. 

Distinguishing Between Interstitial Cystitis and a Urinary Tract Infection

Urinary tract infection (UTI) symptoms are similar to or the same as those found in interstitial cystitis. However, they are not the same thing. As Lisa Hawes, M.D., a female urology specialist at Chesapeake Urology, suggests, women with interstitial cystitis present with negative urine culture results, meaning there are no bacteria in the urine. A UTI, on the other hand, will show bacteria in the urine on a positive test result.

Treatments

Interstitial cystitis goes away on its own in about 50 percent of the cases. However, for those who need treatment, WebMD reports that symptom control is the main goal. It can take weeks or months to calm the symptoms, and it can take a combination of treatments to ease the symptoms. The more conservative therapies should be started first before proceeding to the less conservative treatment.

Four Lines of Treatment

The four lines of treatment include:

  • First line: Avoid triggers and make lifestyle changes.
  • Second line: Consider physical therapy, pain medications, Pentosan, antihistamines, and bladder installations.
  • Third line: Often in an operating room under anesthesia, cystoscopy is necessary to look at the bladder before stretching the wall of the bladder with fluid. Steroids may also be used to remove, burn, or inject any ulcers on the bladder called Hunner’s lesions.
  • Fourth line: If lifestyle changes, medications, and the procedures listed above do not alleviate the symptoms, a urologist may use neurostimulation to shock the nerves or Botox injections to temporarily paralyze the bladder muscle to relieve some of the pain.

Final Step in Treating Interstitial Cystitis

As a last resort, a drug called Cyclosporine can be prescribed to suppress the immune system. Another option is surgery, which may be recommended in very rare cases when other methods fail. This complex procedure involves diverting urine away from the bladder.

Coding for Interstitial Cystitis and Its Treatment

ICD-10-CM Coding for Interstitial Cystitis

ICD-10-CM codes for interstitial cystitis can be found in Chapter 14: Diseases of the genitourinary system (N00-N99), and specifically under block N30-N39, Other diseases of the urinary system (N30-N39) and category N30 Cystitis. Interstitial cystitis (chronic) is further broken down into two codes for “without” and “with” hematuria since blood in the urine (hematuria) is often the first sign of IC.

Locate and verify: To locate the codes in the Index, go to Cystitis (exudative) (hemorrhagic) (septic) (suppurative)/chronic/interstitial/without hematuria N30.10; and with hematuria N30.11. These codes can be verified as:

N30.10, Interstitial cystitis (chronic) without hematuria; and
N30.11, Interstitial cystitis (chronic) with hematuria

Do not confuse the above codes for interstitial cystitis with the other codes listed under N30 for Acute cystitis (N30.0), Other chronic cystitis (N30.2), Trigonitis (N30.3), Irradiation cystitis (N30.4), Other cystitis (N30.8), and Cystitis, unspecified (N30.9).

CPT Coding for Two Common Treatments of IC

Two common procedures performed for interstitial cystitis are a cystoscopy with hydrodistention and a bladder instillation with drug injection. 

Cystoscopy with hydrodistention (hydrodilation):

Cystoscopy with hydrodistention (hydrodilation) is often done under general or local anesthesia. According to UpToDate, a physician inserts fluid into the bladder to stretch it and uses a cystoscope to view the inside of the bladder and urethra. This allows the physician to identify any possible causes for the bladder symptoms. Hunner’s lesions may also be seen in a small number of IC cases. Stretching of the bladder during cystoscopy can sometimes improve the symptoms.

Depending on the anesthesia documented, one of two codes may be reported.

Locate and verify: In the CPT Index, we can look up Bladder/Cystourethroscopy – See Cystourethroscopy. This takes us to Cystourethroscopy/Dilation/Bladder 52260, 52265. These codes can be verified in the Tabular as:

  • 52260, Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia
  • 52265, Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia

Codes 52260 and 52265 may only be used when the procedure is performed on IC patients.

Bladder Instillation:

In a bladder instillation, the physician fills the bladder with a therapeutic solution, or bladder cocktail, through a temporary catheter. UpToDate reports that one such medication, Dimethylsulfoxide (DMSO), is an approved medication used in this treatment. Treatments are often given once a week for at least 6 to 8 weeks to reduce the pain symptoms. There may be several different drugs in the cocktail. 

Locate and verify: To locate the code for the bladder instillation, look up Bladder/instillation 51700. We can verify this code as:

51700, Bladder irrigation, simple, lavage and/or instillation

Per AMA Guidelines, “Codes 51701-51702 are reported only when performed independently. Do not report 51701-51702 when catheter insertion is an inclusive component of another procedure.”

As a rule, local anesthesia, if used, is not billed separately, as it is considered part of the initial procedure. The use of lidocaine or other local analgesics is also not usually reported separately.

HCPCS Code For Drug Injection

Besides CPT code 51700 for bladder instillation, you will also need to report the code for the drug instilled. For example, suppose the documentation indicates that 50 ml of dimethyl sulfoxide (DMSO) 50% aqueous irrigation solution was instilled into the bladder. We would need to look up this code in the HCPCS Index.

Locate and verify: In the HCPCS Index, look up Dimethyl sulfoxide (DMSO). It takes us to J1212, which we can verify as:

J1212, Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml

Short Video

This short one-minute video briefly explains interstitial cystitis and its treatment options.

Conclusion

By diving into the complexities of interstitial cystitis, we have provided you with a comprehensive grasp of diagnostic testing and treatment modalities. Having this knowledge, you are now better prepared to assign ICD-10-CM codes for interstitial cystitis with and without hematuria and select the correct codes for common ICD treatments, including cystoscopy with hydrodistention and bladder instillation/DMSO.  

coding for interstitial cystitis
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5 Comments

  1. Can’t find where potassium sensitivity test is not recommended. It seems to be quite commonly done.

    1. Hi Everett,

      Thank you so much for pointing out my error. I have since revised the post to make it accurate. Great eye for detail! Although the potassium-sensitivity test may still be used by some physicians as a diagnostic tool, it is no longer recommended, according to the link I provided above. The AUA reports it is not “useful” and can be painful and trigger a severe symptom flare. I’m glad you found this topic of interest.

    2. Hi Teresa.

      I’m sorry to hear about your experience. Yes, the AUA (American Urological Association) states it is ineffective and unnecessarily painful to patients. This is why it is not used as commonly by urologists as it once was.

      Thanks for your input.

  2. Do you bill for each drug (such as sodium bicarbonate) used in a bladder installation cocktail performed in the office? And if so, how? We are a multi-specialty group, affiliated with a hospital and the Pharmacy mixes the cocktail for the office. I get different answers from different sources, so I don’t know what is correct. Thank you.

    1. Hi Christine,

      I would think the billing for each drug used in the cocktail would depend on the individual payer. However, billing is not my area of expertise. My focus is on helping students working towards their CPC certifications. Hopefully, you will get your answer.

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