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Coding for Pyelonephritis Due to Pseudomonas Aeruginosa

coding for pyelonephritis due to Pseudomonas aeruginosa
Acute pyelonephritis occurs as a complication of a UTI.
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** This post was reviewed and updated on January 5, 2024. **

The Coding Challenge

Question: A patient is diagnosed with acute pyelonephritis caused by Pseudomonas aeruginosa. The 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

What is Acute Pyelonephritis?

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.

coding for pyelonephritis due to Pseudomonas aeruginosa

Locate and Verify

Acute Pyelonephritis

Look in the Alphabetic Index under Pyelonephritis/acute N10. We can then verify this code in the Tabular as:

N10, Acute pyelonephritis

Inclusion terms for N10 include:

  • Acute infectious interstitial nephritis
  • Acute pyelitis
  • Acute tubulointerstitial nephritis
  • Hemoglobin nephrosis
  • Myoglobin nephrosis

A note at N10 states:

Use additional code (B95-B97) to identify infectious agent.

The infectious agent documented is Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the potential causative organisms in acute pyelonephritis.

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, which takes us to: 

B96.5, Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere 

A note at A00-B99 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 tell us when there is a bacterial infection not included in Chapter 1, the coder may need to report a secondary code from B95 or B96 to identify the bacterial organism causing the infection. In the above scenario, the acute pyelonephritis reported with N10 is included in Chapter 14 (not Chapter 1), and the causal bacterial organism, Pseudomonas aeruginosa, is reported with B96.5. Therefore, 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 follow-up 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 the 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 Non-obstructive 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 (Z87.440) is missing here for the personal history of UTIs. 

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. 


How did you do? If you had a little trouble, no worries. Keep on practicing and you’ll get there.

coding for pyelonephritis due to pseudomonas aeruginosa
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