Coding Clinic for ICD-9-CM, Second Quarter 2010, page 3, provided advice to sequence gross hematuria as the principal diagnosis for a patient, who was currently under treatment for prostate cancer and was admitted for gross hematuria with a significant drop in hemoglobin. The patient had been unable to pass urine and was only passing frank blood and clots. While in the hospital, 12 units of blood were transfused, and bladder irrigation was done. Now that hematuria is a Chapter 18 code in ICD-10-CM does the guideline in Section II.A., regarding codes for symptoms, signs, and ill-defined conditions apply, and change the previously published advice in regards to the principal diagnosis?
The Official Guidelines for Coding and Reporting state, “Codes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established.” Based on this guideline and the fact that hematuria is classified as a symptom in ICD-10-CM, code C61, Malignant neoplasm of prostate, would now be assigned as the principal diagnosis. Code R31.0, Gross hematuria, would be assigned as a secondary diagnosis. This is also consistent with the neoplasm guidelines regarding symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasms.
The previously published advice was based on the application of the guideline regarding the selection of principal diagnosis as ICD-9-CM did not classify hematuria in the symptom chapter. This is an example of differences in the ICD-10-CM classification compared to ICD-9-CM.