Preparing for the Transition to ICD-10 by Chart Reviews of Four Urology Practice Types

Coding Corner Preparing for the Transition to ICD-10 by Chart Reviews of Four Urology Practice Types Jonathan Rubenstein, MD Chesapeake Urology Associates, Baltimore, MD [Rev Urol. 2015;17(2):88-96 doi:10.3909/riu0680] ® © 2015 MedReviews , LLC O n October 1, 2015, coding for medical encounters in the United States will change to the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code set, replacing the ICD-9 code set. Compared with ICD-9, ICD-10 has a novel structure that is greatly expanded in its specificity. In addition, ICD-10 contains new code types and new billing rules that must be understood for proper coding. This change may create great challenges for providers and billing staff. Providers will need to provide documentation to support the specific code chosen, based on the codes that are available. To evaluate how an individual urologist may be affected by this transition, a review of charts was undertaken. From a random date, 20 consecutive office charts were reviewed from a general urologist, a male health/infertility subspecialist, a pelvic floor/reconstruction subspecialist, and a pediatric subspecialist. The results and an analysis of the review can be used to give a practicing urologist a sense of the transition to ICD-10, and to highlight some challenges that may be expected. General Urologist In the 20 patients reviewed, there were 36 total ICD-9 codes chosen (Table 1); 25 of the 36 ICD-9 codes (69.4%) have a 1:1 conversion to ICD-10 (if selected appropriately in ICD-9), whereas 11 codes (6 conditions) have more complexity, such as a 1to-multiple transition, or require more information for accurate coding. The 1:1 conversion conditions included urinary symptoms (dysuria, slow urinary stream, and urinary frequency), elevated prostatespecific antigen level, kidney stone, prostate cancer, bladder cancer with location specified, autosomal dominant polycystic kidney disease, neoplasm of unspecified behavior of other genitourinary organ, abnormal urine, hypogonadism, benign prostatic hyperplasia with lower urinary tract symptoms, and nodular prostate with lower urinary tract symptoms. Please note that, although kidney stone has a 1:1 conversion from ICD-9 code 192.0 to ICD-10 code N20.0, there are also new codes for ureteral calculus (N20.1), calculus of the kidney and ureter (N20.2), and hydronephrosis due to renal and ureteral calculus (N13.2). Similarly, there are codes for other 88 • Vol. 17 No. 2 • 2015 • Reviews in Urology 4004170006_RIU0680.indd 88 02/07/15 4:28 PM ICD-10 Transition TABLE 1 ICD Office Chart Reviews of the General Urologist Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code Comments 1 Urinary frequency Elevated PSA 788.41 790.93 R35.0 R97.2 1:1 conversion (symptom) 1:1 conversion (symptom) 2 Neoplasm of uncertain behavior of unspecified kidney 239.5 D49.5 Code is actually neoplasm of unspecified behavior of other genitourinary organ (vs neoplasm unspecified bladder [D49.4]) 3 Erectile dysfunction 607.84 N52.01 Slow urinary stream Hypogonadism Proteinuria 788.62 257.2 791.0 R39.19 E29.1 R80.- 12 erectile dysfunction codes in N52 section based on etiology 1:1 conversion (symptom) 1:1 conversion Specify if isolated (N80.0), persistent (N80.1), orthostatic (N80.2), Bence-Jones (N80.3), other (N80.8) or unspecified (N80.9) 4 Hypogonadism BPH with LUTS Erectile dysfunction 257.2 600.01 607.84 E29.1 N40.1 N52.- 1:1 conversion 1:1 conversion (combination code) 12 erectile dysfunction codes in N52 section based on etiology 5 Prostate cancer 185 C61 1:1 conversion 6 Abnormal urine odor 791.9 R82.90 Code is unspecified abnormal finding in urine compared with a specific finding 7 Elevated PSA Nodular prostate with LUTS 790.93 600.11 R97.2 N40.3 1:1 conversion (symptom) 1:1 conversion (combination code) 8 Prostate cancer Urethral stricture 185 598.9 C61 N35.- 1:1 conversion ICD-10 has 21 codes based on sex, etiology (trauma, infection, procedure) and location, plus 4 congenital codes (Q64.3-) 9 Kidney stone 592.0 N20.0 1:1 conversion 10 Elevated PSA 790.93 R97.2 1:1 conversion (symptom) Slow urinary stream 788.62 R39.19 1:1 conversion (symptom) Prostate cancer Erectile dysfunction 185 607.84 C61 N52.- Bladder CA, trigone 188.0 C67.0 1:1 conversion 12 erectile dysfunction codes in N52 section based on etiology 1:1 conversion if chose specific bladder location in ICD-9 12 Dysuria 788.1 R30.0 1:1 conversion (symptom) 13 Renal cell CA, right 189.0 C64.1 Laterality (right vs left) in ICD-10 for urology neoplasms 14 Kidney stone 592.0 N20.0 1:1 conversion 11 Vol. 17 No. 2 • 2015 • Reviews in Urology • 89 4004170006_RIU0680.indd 89 02/07/15 4:28 PM ICD-10 Transition continued TABLE 1 ICD Office Chart Reviews of the General Urologist (Continued ) Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code Elevated PSA Proteinuria 790.93 791.0 R97.2 R80.9 Urinary retention 788.20 R33.- Acute cystitis 595.0 N30.0- ADPKD 753.13 Q61.2 17 Acute cystitis 595.0 N30.- ICD-10 has unique codes for acute cystitis without hematuria (N30.00) or with hematuria (N30.01) 18 Kidney stone Acute cystitis 592.0 595.0 N20.0 N30.0 1:1 conversion ICD-10 has unique codes for acute cystitis without hematuria (N30.00) or with hematuria (N30.01) 19 Elevated PSA Dysuria 790.93 788.1 R97.2 R30.0 1:1 conversion 1:1 conversion 20 Bladder CA, posterior 188.4 C67.4 1:1 conversion if chose specific bladder location in ICD-9 15 16 Comments 1:1 conversion (symptom) Specify if isolated (N80.0), persistent (N80.1), orthostatic (N80.2), Bence-Jones (N80.3), other (N80.8), or unspecified (N80.9) Specify due to drug (R33.0), other (R33.9) or unspecified (R33.9) ICD-10 has unique codes for acute cystitis without hematuria (N30.00) or with hematuria (N30.01) 1:1 conversion; other codes for infantile type (Q61.19), congenital single/multiple cysts (Q61.01/.02), acquired (N28.1) ADPKD, autosomal dominant polycystic kidney disease; BPH, benign prostatic hyperplasia; CA, cancer; ICD, International Classification of Diseases and Related Health Problems; LUTS, lower urinary tract symptoms; PSA, prostate-specific antigen. polycystic disease (infantile type has an ICD-10 code of Q61.19) and other congenital cyst codes. The six conditions for which there is complexity in ICD-10 compared with ICD-9 in this group include erectile dysfunction, proteinuria, cystitis, kidney cancer, urinary retention, and urethral stricture. This means that the provider must have an understanding of approximately 44 additional codes, or at least know the basics with regard to the coding details needed for accurate documentation. In ICD10, erectile dysfunction is expanded to 12 codes, based on the etiology of the condition (eg, due to arterial, venous occlusive, or combined arterial and venous disease; due to drug; due to 1 of 5 pelvic surgeries, each with its own code; or due to underlying disease, other, or unspecified), which does not even include the sexual dysfunction codes (5 ejaculatory dysfunction codes, along with other and unspecified) and the nonorganic code (found in the Mental, Behavioral, and Neurodevelopmental Disorders chapter). Proteinuria has six unique codes. In ICD-10, acute cystitis has two codes, as it is coded in combination as being with or without hematuria; there is no option for acute cystitis alone without this further detail. Malignant neoplasm of the kidney except renal pelvis contains unique codes for right and left side (laterality) along with a code for unspecified side. Urinary retention has three codes, based on whether it is due to drug, other, or unspecified. Urethral stricture has 25 code choices, based on whether it is congenital (4 codes), and based on sex, etiology, and location. Male Health/Infertility Subspecialist In the 20 patients reviewed, the male health/infertility subspecialist used 29 total ICD-9 codes, although from reading through the documentation details, it appears that at least three further diagnoses were discussed 90 • Vol. 17 No. 2 • 2015 • Reviews in Urology 4004170006_RIU0680.indd 90 02/07/15 4:28 PM ICD-10 Transition TABLE 2 ICD Office Chart Reviews of the Male Health/Infertility Subspecialist Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 1 Fertility testing 257.2 E29.1 Hypogonadism code was chosen, rather than a male infertility code 2 Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology Urinary frequency 788.41 R35.0 1:1 conversion Peyronie disease 607.85 N48.6 1:1 conversion Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology 4 Hypogonadism 257.2 E29.1 1:1 conversion 5 Nocturia 788.43 R35.1 1:1 conversion Hypogonadism 257.2 E29.1 1:1 conversion 6 Phimosis 605 N47.1 ICD-10 has separate codes for phimosis (N47.1) and paraphimosis (N47.2) 7 Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology 8 Testicular pain 608.9 N50.8 N50.8 is other specified disorders of male genital organs, whereas N50.9 is unspecified 9 Male infertility evaluation 257.2 N46.9 Many possible codes, including Z31.41, encounter for fertility testing (not primary code), N46, male infertility codes 10 Hypogonadism 257.2 E29.1 1:1 conversion Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology Peyronie disease 607.85 N48.6 1:1 conversion Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology Male infertility evaluation 257.2 E29.1 Hypogonadism code was chosen, rather than a male infertility code Abnormal semen 257.2 E29.1 Hypogonadism code was chosen, rather than abnormal semen Varicocele 456.4 I86.1 1:1 conversion Testicular pain 608.9 N50.8 N50.8 is other specified disorders of male genital organs, whereas N50.9 is unspecified Varicocele 456.4 I86.1 1:1 conversion Oligospermia Not coded N46.- 7 specific oligospermia codes, based on whether organic (N46.01) or due to one of 6 extratesticular causes (N46.02-) Male infertility evaluation Not coded N46.9 Many possible codes, including Z31.41, encounter for fertility testing (not primary code), N46.9, male infertility unspecified 3 11 12 13 14 Comments Vol. 17 No. 2 • 2015 • Reviews in Urology • 91 4004170006_RIU0680.indd 91 02/07/15 4:28 PM ICD-10 Transition continued TABLE 2 ICD Office Chart Reviews of the Male Health/Infertility Subspecialist (Continued ) Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 15 Male infertility evaluation 257.2 E29.1 Hypogonadism code was chosen, rather than a male infertility code 16 Hypogonadism 257.2 E29.1 1:1 conversion 17 Erectile dysfunction 607.84 18 Check fertility status 257.2 E29.1 Hypogonadism code was chosen, rather than a male infertility code 19 Hypogonadism 257.2 E29.1 1:1 conversion Erectile dysfunction 607.84 N52.- 12 erectile dysfunction codes in N52 section based on etiology History of vasectomy not coded Z98.52 Vasectomy status (not primary code) Peyronie disease 607.85 N48.6 1:1 conversion 20 Comments 12 erectile dysfunction codes in N52 section based on etiology ICD, International Classification of Diseases and Related Health Problems. and treated, yet no ICD-9 code was chosen for billing purposes (Table 2); 12 of the 29 codes (7 conditions; 41.4%) had a 1:1 conversion from ICD-9 to ICD-10, whereas 17 codes (5 conditions) did not. The codes with a simple conversion include the urinary symptom codes (urinary frequency, nocturia), varicocele, Peyronie disease, and hypogonadism. Of the 11 patients for whom hypogonadism was chosen as a diagnosis, five had true hypogonadism (and therefore were included in the 1:1 conversion category), whereas six were being seen for male infertility issues and were therefore put into the complex category. In ICD-9, code 605 encompassed a number of penile conditions, including phimosis, paraphimosis, redundant foreskin, or adherent prepuce. In ICD-10, each of these conditions has a unique code: N47.0 for adherent prepuce of newborn, N47.1 for phimosis, N47.2 for paraphimosis, N47.5 for adhesions of prepuce and glans, and N47.8 for other disorders of prepuce (including redundant foreskin). For patients who present for fertility testing or due to male infertility issues, there are a number of different available codes. In ICD-10, there are 16 male infertility codes in the N46 section (organic azoospermia and 6 extratesticular causes of azoospermia, organic oligospermia, and 6 extratesticular causes of oligospermia, other and unspecified male infertility), 10 codes for abnormal findings in semen (R86 section), checking vasectomy status (Z98.52, which cannot be used as a primary code), and encounter for fertility testing (Z31.41, which also cannot be used as a primary code). The ICD-9 code for erectile dysfunction was used eight times. The two patients who had testicular pain were given the ICD-9 code of 608.9, which is unspecified disorder of male genital organs; the patient with postvasectomy pain may be given the ICD-10 code N99.89 (other postprocedural complications of the genitourinary tract), and N29.1 (inflammatory disorder of the spermatic cord). Pediatric Subspecialist The pediatric subspecialist used 26 total ICD-9 codes in the 20 patients reviewed (Table 3). There was a simple 1:1 conversion for 5 of the 26 codes (3 conditions; 19.2%) with complexity in the remaining 21 codes (13 conditions). The simple 1:1 conversion codes included comedone, enuresis, and inguinal hernia without obstruction or gangrene. Conditions that may have more than one ICD-10 code choice in this group include the patients with phimosis, paraphimosis, redundant foreskin, meatal stenosis, unspecified urinary tract infection, constipation, bladder diverticulum, and buried penis. The ICD-9 code 599.0 is an unspecified urinary tract infection (ICD-10 N39.0); each of the patients seen had the more specific diagnosis of acute cystitis (ICD-9 595.0), which has two codes in ICD-10: acute cystitis without hematuria (N30.00), and acute cystitis with hematuria (N30.01). Constipation can be unspecified (which was 92 • Vol. 17 No. 2 • 2015 • Reviews in Urology 4004170006_RIU0680.indd 92 02/07/15 4:28 PM ICD-10 Transition TABLE 3 ICD Office Chart Reviews of the Pediatric Subspecialist Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 1 Undescended testicle 752.51 Q53.- Unique ICD-10 codes based on whether ectopic, unilateral vs bilateral, location (abdominal, perineal, unspecified) 2 Hydronephrosis 591 Q62.0 ICD-10 has unique codes for congenital hydronephrosis (Q62.0), unspecified N13.30, other N13.39, others 3 Comedone 078.11 A63.0 1:1 conversion 4 Undescended testicle 608.3 N50.0 The code chosen was for testicular atrophy, which would convert to N50.0; a Q53 code could have been chosen 5 Hydronephrosis 591 Q62.0 ICD-10 has unique codes for congenital hydronephrosis (Q62.0), unspecified N13.30, other N13.39, others Phimosis 605 N47.1 ICD-10 has separate codes for adherent prepuce of newborn (N47.0), phimosis (N47.1), and paraphimosis (N47.2) 6 Redundant foreskin 605 N47.8 Redundant foreskin is best coded as other disorders of prepuce (N47.8) 7 Redundant foreskin 605 N47.8 Redundant foreskin is best coded as other disorders of prepuce (N47.8) 8 Phimosis 605 N47.1 ICD-10 has separate codes for adherent prepuce of newborn (N47.0), phimosis (N47.1), and paraphimosis (N47.2) 9 Meatal stenosis 598.9 Q64.33 Incorrect ICD-9 chosen; should have chosen ICD-9 753.6 for meatal stenosis, not unspecified urethral stricture Hypospadias 752.61 Q54.- Unique codes by location: balanitic Q54.0, penile Q54.1, penoscrotal Q54.2, perineal Q54.3, other Q54.8, unspecified Q54.9 Urinary tract infection 599.0 N39.0 Should have chosen acute cystitis without hematuria (N30.00) or acute cystitis with hematuria (N30.01) Bladder dysfunction 596.59 N31.9 Unspecified code chosen, whereas many specific codes exist Constipation, unspecified 564.00 K59.00 ICD-10 also has codes for slow transit (K59.01), outlet obstruction (K59.02), other (K59.09), or neurogenic bowel (K59.2) 11 Phimosis 605 N47.1 ICD-10 has separate codes for adherent prepuce of newborn (N47.0), phimosis (N47.1), and paraphimosis (N47.2) 12 Incontinence 788.30 R32 Unspecified code chosen, whereas many specific incontinence codes exist Enuresis 788.36 N39.44 1:1 conversion 10 Comments Vol. 17 No. 2 • 2015 • Reviews in Urology • 93 4004170006_RIU0680.indd 93 02/07/15 4:28 PM ICD-10 Transition continued TABLE 3 ICD Office Chart Reviews of the Pediatric Subspecialist (Continued ) Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 13 Hydronephrosis 591 Q62.0 ICD-10 has unique codes for congenital hydronephrosis (Q62.0), unspecified N13.30, other N13.39, others 14 Paraphimosis 605 N47.2 ICD-10 has separate codes for adherent prepuce of newborn (N47.0), phimosis (N47.1), and paraphimosis (N47.2) 15 Enuresis 788.36 N39.44 1:1 conversion 16 Enuresis 788.36 N39.44 1:1 conversion 17 Urinary tract infection 599.0 N39.0 Should have chosen acute cystitis without hematuria (N30.00) or acute cystitis with hematuria (N30.01) Bladder diverticulum 596.3 Q64.6 Q64.6 if congenital, N32.3 if not congenital 18 Inguinal hernia w/o gangrene 550.01 K40.90 1:1 conversion 19 Hidden penis 752.65 Q55.64 ICD-10 has unique codes for buried/hidden penis that is congenital (Q55.64) vs acquired (N48.83) 20 Phimosis 605 N47.1 ICD-10 has separate codes for adherent prepuce of newborn (N47.0), phimosis (N47.1), and paraphimosis (N47.2) Comments ICD, International Classification of Diseases and Related Health Problems. chosen), or due to other, more specific conditions. Congenital bladder diverticulum has a single ICD-10 code (Q64.6) but needs to be differentiated from noncongenital diverticulum (N32.3). Congenital meatal stenosis has a single ICD-10 code; in this review, however, the ICD-9 code for urethral stricture unspecified (598.9) was chosen rather than the more specific congenital meatal stenosis code (ICD-9 753.6). In ICD-10, there is a unique code for congenital hydronephrosis (Q62.0). It is important for documentation and coding purposes to differentiate congenital hydronephrosis from other types of hydronephrosis found in ICD-10, such as hydronephrosis due to ureteral stricture (N13.1), due to stone (N13.2), other (N13.39), and unspecified (N13.30). Undescended testicle has 10 unique codes, based on whether the condition is unilateral or bilateral, if it is ectopic, undescended abdominal, undescended perineal, or unspecified. Hypospadias has six codes based on location, other, or unspecified. In this review, ICD-9 code 596.59 was chosen for bladder dysfunction, which is an unspecified code. Other codes exist, including a variety of codes for neurogenic bladder (ICD-9 596.54), which have a number of more specific ICD-10 codes based on the bladder function (uninhibited, reflex, flaccid, other, and unspecified) and/or underlying cause (cord, cauda equina syndrome, or spinal cord injury). In one case, a code for testicular atrophy was chosen (ICD-9 608.3); this would have a 1:1 conversion to N50.0 if it had been the correct ICD-9 code based on the patient’s presentation, but the patient was being evaluated for an undescended testicle. Pelvic Floor/ Reconstruction Subspecialist In this review, 34 codes were selected for the 20 patients seen (Table 4); 21 of the 34 codes (8 conditions, 61.8%) have a 1:1 conversion from ICD-9 to ICD10, including urinary symptoms (urge urinary incontinence, urinary urgency, overactive bladder, stress incontinence, mixed incontinence), microscopic hematuria, kidney stone, and urethral 94 • Vol. 17 No. 2 • 2015 • Reviews in Urology 4004170006_RIU0680.indd 94 02/07/15 4:28 PM ICD-10 Transition TABLE 4 ICD Office Chart Reviews of the Pelvic Floor/Reconstruction Subspecialist Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 1 Cystocele, unspecified 618.00 N81.10 ICD-9 and ICD-10 have specific codes for cystocele midline (N81.11), lateral (N81.12), and other types of prolapse 2 Neurogenic bladder, unspecified 596.54 N31.9 Specific codes for uninhibited NGB (N31.0), reflex (N31.1), flaccid (N13.2), other (N13.8), cauda equina (G83.4), others Urge urinary incontinence 788.31 N39.41 1:1 conversion Urinary urgency 788.63 R39.15 1:1 conversion (symptom) 3 Cystocele 618.00 N81.10 ICD-9 and ICD-10 have specific codes for cystocele midline (N81.11), lateral (N81.12), and other types of prolapse 4 Overactive bladder 596.51 N32.81 1:1 conversion Microscopic hematuria 599.72 R31.2 1:1 conversion (symptom) 5 Interstitial cystitis 595.1 N30.1- ICD-10 requires specifically if without hematuria (N30.10) or with hematuria (N30.11) 6 Urge urinary incontinence 788.31 N39.41 1:1 conversion Mixed incontinence 788.33 N39.46 1:1 conversion Overactive bladder 596.51 N32.81 1:1 conversion Stress incontinence female 625.6 N39.3 Note: male and female stress incontinence is one code in ICD-10 Bladder mass 596.89 N32.89 Unspecified disorder of bladder (N32.89) or D49.4 neoplasm of unspecified behavior bladder Mixed incontinence 788.33 N39.46 1:1 conversion Overactive bladder 596.51 N32.81 1:1 conversion Urge urinary incontinence 788.63 R39.15 1:1 conversion Kidney stone N20.0 1:1 conversion Urge urinary incontinence 788.31 N39.41 1:1 conversion Multiple sclerosis not coded G35 Underlying cause of neurogenic bladder may be indicated Tobacco use 305.1 Z72.0 or F17.000 nicotine dependence (not primary code) Urinary tract infection 599.0 N39.0 Should have chosen acute cystitis without hematuria (N30.00) or acute cystitis with hematuria (N30.01) Microscopic hematuria 599.72 R31.2 1:1 conversion (symptom) Urge urinary incontinence 788.31 N39.41 1:1 conversion Mixed incontinence N39.46 1:1 conversion 7 8 9 10 11 12 592.0 788.33 Comments Vol. 17 No. 2 • 2015 • Reviews in Urology • 95 4004170006_RIU0680.indd 95 02/07/15 4:28 PM ICD-10 Transition continued TABLE 4 ICD Office Chart Reviews of the Pelvic Floor/Reconstruction Subspecialist (Continued ) Patient No. Symptom or Diagnosis ICD-9 Chosen ICD-10 Code 13 Urinary retention 788.29 N33.- Specify if due to drug (R33.0), other (R33.9), or unspecified (R33.9) 14 Urge urinary incontinence 788.31 N39.41 1:1 conversion Urinary retention 788.20 R33.- Specify if due to drug (R33.0), other (R33.9), or unspecified (R33.9) 15 Microscopic hematuria 599.72 R31.2 1:1 conversion (symptom) 16 Urethral caruncle 599.3 N36.2 1:1 conversion 17 Interstitial cystitis 595.1 N30.1- Need to know if without hematuria (N30.10) or with hematuria (N30.11) Urinary tract infection 599.0 N39.0 Should have considered acute cystitis 595.0 as a more specific code Urinary tract infection 599.0 N39.0 Should have considered acute cystitis 595.0 as a more specific code Bladder diverticulum 596.3 N32.3 Versus Q64.6 if congenital 18 Comments 19 Urge urinary incontinence 788.31 N39.41 1:1 conversion 20 Urethral caruncle N36.2 1:1 conversion 599.3 ICD, International Classification of Diseases and Related Health Problems. caruncle. This number could have been higher had more specific ICD-9 codes been chosen rather than unspecified codes. For example, cystocele has specific codes based on whether it is lateral or midline in both ICD-9 and ICD10, in addition to other prolapse codes. In ICD-10, urinary retention has several codes, as does neurogenic bladder (based on etiology). Interstitial cystitis has unique ICD-10 codes based on whether it exists without hematuria (N30.10) or with hematuria (N30.11). Discussion It is important to recognize that ICD-10 is not merely a more specific and expanded code set from ICD-9, but rather is its own unique system. Along with increased specificity come new rules, new language, and a new structure. A number of codes do have a 1:1 conversion between the two code sets; some will have a 1-to-multiple conversion from ICD-9 to ICD-10, and others are completely different. Providers who are more comfortable with ICD-9 may find the transition to ICD-10 a bit easier. Those who currently use a high number of unspecified codes may encounter more challenges. A pediatric subspecialist may need to make more changes to his or her typical work day than someone whose practice uses a high number of urinary symptom codes. Providers will need to adjust their documentation to support the corresponding ICD-10 codes. This review highlights areas that individual providers may study based on their own practice patterns. 96 • Vol. 17 No. 2 • 2015 • Reviews in Urology 4004170006_RIU0680.indd 96 02/07/15 4:28 PM