Coding for Pyelonephritis Due to Pseudomonas Aeruginosa
Patient is diagnosed with acute pyelonephritis caused by Pseudomonas aeruginosa. Patient has a history of UTIs. Assign for ICD-10-CM.
A. N11.0, B96.5, Z87.411
B. N10, B96.5, Z87.440
C. N11, B96.89
D. N11, B97.89, Z84.1
Answer:
B. N10, B96.5, Z87.440
Acute pyelonephritis is a bacterial infection that causes inflammation of the kidneys and occurs as a complication of a urinary tract infection (UTI). Pseudomonas aeruginosa is one of the potential causative organisms in acute pyelonephritis.
Locate and Verify
Acute Pyelonephritis
Look in the Alphabetic Index under Pyelonephritis/acute N10. This code can then be verified in the Tabular as:
N10, Acute pyelonephritis
Inclusion terms for N10 include:
- Acute infectious interstitial nephritis
- Acute pyelitis
- Acute tubulo-interstitial nephritis
- Hemoglobin nephrosis
- Myoglobin nephrosis
There is a note at N10 that states:
Use additional code (B95-B97) to identify infectious agent.
The infectious agent documented is Pseudomonas.
Pseudomonas Aeruginosa
In the Index, we can look under Pseudomonas/aeruginosa, as cause of diseases classified elsewhere B96.5. To verify this code, we need to go to the Tabular Listing, which takes us to:
B96.5, Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere.
There is a note at A00-B99 that states:
These categories are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere.
The “Use additional code” note at N10 indicates that a secondary code should be added.
Also, the ICD-10-CM Official Guidelines for Coding and Reporting states:
“… for bacterial infections that are not included in chapter 1, a secondary code from category B95, Streptococcus, Staphylococcus, and Enterococcus, as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, may be required to identify the bacterial organism causing the infection. A “use additional code” note will normally be found at the infectious disease code, indicating a need for the organism code to be added as a secondary code.”
So, N10 should be sequenced first, followed by B96.5.
History of Urinary Tract Infections
The documentation also states that the patient has a history of UTIs (urinary tract infections).
The ICD-10-CM official coding guidelines state,
“Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring… Personal history codes may be used in conjunction with followup codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.”
Looking in the Alphabetic Index, see History/personal (of)/urinary (recurrent) (tract) infection(s) Z87.440. We can verify this code in the Tabular as:
Z87.440, Personal history of urinary (tract) infections
Incorrect Answers
A, C, and D are incorrect.
A. N11.0, B96.5, Z87.411. N11.0 refers to Nonobstructive reflux-associated chronic pyelonephritis. Z87.411 refers to Personal history of vaginal dysplasia.
C. N11, B96.89. N11, Chronic tubulo-interstitial nephritis, is an invalid code and requires a 4th digit. B96.89 refers to Other specified bacterial agents as the cause of diseases classified elsewhere. The Z code is missing here for the personal history of UTIs (Z87.440).
D. N11, B97.89, Z84.1. Again, N11 is an invalid code. B97.89 refers to Other viral agents as the cause of diseases classified elsewhere. Z84.1 refers to Family history of disorders of kidney and ureter.
** This article has been updated to reflect the ICD-10-CM Coding Guidelines for FY 2022. **
How did you do? If you had a little trouble, no worries. Keep on practicing and you’ll get there.
