A patient with an ileal conduit neobladder is admitted with fever and abdominal discomfort due to acute pyelonephritis. A query to the provider clarified recurrent acute pyelonephritis secondary to ileal conduit. How should this condition be coded?
Assign code T83.598A, Infection and inflammatory reaction due to other prosthetic device, implant and graft in urinary system, initial encounter, for the infection of the ileal conduit neobladder. Assign code N10, Acute pyelonephritis, along with a code for the infectious agent, if known. The ileum, functioning as the patient’s bladder (neobladder), has developed an infection, and this infection has spread to the kidney, causing acute pyelonephritis.
Code T83.598 may be located in the Index to Diseases as follows:
Infection, infected, infective
-due to or resulting from
--device, implant, or graft (see also Complications, by site and type, infection or inflammation)
--urinary NEC T83.598
Complication(s) (from) (of)
-graft (bypass) (patch) (see also Complications, prosthetic device or implant)
---infection and inflammation T83.598
This answer differs from that previously published in Coding Clinic First Quarter 2016, page 19, about cancer of a neobladder. In that example, invasion of cancer into the neobladder was not coded as a complication of the graft since carcinoma of a surgically created neobladder is not classified as a complication of the graft. However, ICD-10-CM does differentiate infections of a graft/device from a typical urinary organ infection and classifies an infection of a graft as a complication.