In order to correctly report a patient’s condition, and to process the claims for the healthcare services provided and the cost of the supplies, it is important for an organization to be familiar with the coding systems that are applied to the US healthcare system, namely the HCPCS, CPT and the ICD.
When it comes to coding for incontinence, it is equally important to be familiar with the ICD 9 code set as well as the ICD 10. According to a report, more than 90% of the claims submitted dealing with incontinence were done incorrectly. For correct coding, it is required by medical coders to be adept in the various code sets required in the process, as well as successfully crosswalk between the ICD 9 code for incontinence in bladder and feces, and the corresponding ICD 10 codes.
What is Incontinence?
Incontinence is the involuntary leakage of urine or feces, although it is more commonly referred to as urinary incontinence. The cause is usually a weak urinary sphincter muscle so that the affected person loses control over when they have to urinate.
Urinary incontinence is a fairly common condition affecting many people in the US. According to the American Urological Association, more than a quarter of the US adult population experience a type of urinary incontinence or another. Another analysis shows that women are more apt to suffer from urinary incontinence than men.
The condition is attributed to factors that can bring on stress to the body, such as coughing. Urinary incontinence can also be brought on by recent pregnancy, while the most common cause is obesity. Chances of contracting incontinence usually increase with age.
Types and Symptoms
Incontinence is some people are occasional, minor leaks of urine, while for others, it can mean more frequent leakage of urine in moderate amounts. Below are the common types of urinary incontinence and their symptoms:
Urge Incontinence
Characterized by sudden urges of urine followed by an involuntary loss of urine. The feel to urinate is frequent, sometimes 7 or 8 times in a single night. Urge incontinence is caused by bladder infections, diabetes, or a severe neurological disorder.
Stress Incontinence
Urine leakage is caused by stress factors that exert pressure on the bladder, including sneezing, coughing, exercising, and even laughing.
Functional Incontinence
Attributed to a mental or physical impairment that keeps the person from making it to the toilet in time.
Overflow Incontinence
In this type, the patient’s bladder does not empty completely, which results in constant dribbling of urine.
Mixed Incontinence
Mixed incontinence is described when a patient has symptoms of more than one type of incontinence. Often, mixed continence comprises urge and stress incontinence.
Causes
Urinary Incontinence is attributed to everyday habits, physical problems, and sometimes an underlying medical condition. It is up to the healthcare provider to identify the cause and provide treatment accordingly. When diagnosing the cause, incontinence can be segregated into two types: temporary and persistent urinary incontinence.
Temporary urinary incontinence
Temporary continence is often caused by diuretics that stimulate the bladder and thus increase the volume of urine being produced. Diuretics can include drinks, medications, and certain foods.
Moreover, a temporary urinary incontinence case is the result of an easily treatable medical condition such as constipation and a urinary tract infection.
Persistent urinary incontinence
The persistent form of the condition is commonly caused by an underlying medical condition or a health problem, such as hormonal changes and the increased pressure by the fetus during pregnancy, weakness of the vaginal muscles during childbirth, menopause, enlarged prostate, and prostate cancer.
As you get older, the bladder ages too. This means that the bladder muscles do not allow the same capacity to store urine as before. The contractions in the bladder are also more frequent with age
About the ICD
The International Classification of Diseases (ICD) is a diagnostic tool that is used as a standard to monitor and classify the different diseases and their causes. The information maintained through the ICD is used to perform health analyses and to collect morbidity and mortality trends. Through the ICD, international compatibility in the collection and reporting of health data is made possible.
Attempts to systematically classify diseases have been ongoing as far as the 1700s but were of little use owing to the discrepancies in the nomenclature back then. In later years, the importance of a standard to document and classify diseases was realized, paving the way for the International Statistical Institute. In 1893, the first international classification of diseases was adopted.
The ICD, with each revision, became more detailed and accurate, especially after the World Health Organization assumed ownership in 1948. The WHO rigorously started collecting international data for all general epidemiological surveillance and health management purposes. The International Classification of Disease was considerably revised and improved in the 1990s, resulting in the ICD 10 which replaced the ICD 9 worldwide in countries that applied the classification. The US formally transitioned to the ICD 10 in 2015.
The ICD contains a list of all known injuries and diseases along with their descriptions. Each injury and disease is given a unique identifier that is used as a diagnostic characteristic. Using the diagnostic codes, mortality and morbidity data is extracted from clinical and patient records. The countries that have subscribed to the ICD system have applied the code set in varying degrees. Some countries adopt the system entirely in their medical systems, while others use the ICD in hospitals only to aid in the collection of morbidity and mortality data.
ICD 9 Code Set
It was felt by the US Department of Health and Human Services that there was a dire need to provide better clinical information based on the data on diseases and injuries. Hence, the ICD 9 CM came into being and was incorporated into the US healthcare system. The codes in the CM version are more precise and allow for better analyses. The ICD 9 code set was used widely in healthcare facilities and hospitals to better report on morbidity data while the ICD 10 was used to report mortality data.
The ICD 9 code set is made up of a tabular list of diseases, where each disease is attributed by a unique numerical identifier. The disease entries are made of an alphabetical index and a classification system is applied to systematically order the diagnostic, surgical, and therapy procedures.
ICD 9 Code for Incontinence
The general ICD 9 code for urinary incontinence is 788.30 that can be used to indicate a diagnosis for reimbursement on claims before October 1, 2015. The ICD 10 effectively replaced the ICD 9 after that date and is required for all cases to use the latest ICD 10.
Here is a list of some of the commonly used ICD 9 codes for incontinence:
– Urinary incontinence 788.30
– Stress incontinence (female) 625.6
– Stress incontinence (male) 788.32
– Urge incontinence 788.31
– Mixed incontinence 788.33
– Nocturnal enuresis 788.36
– Continuous leakage 788.37
– Overflow incontinence 788.38
– Other specified urinary incontinence 788.39
What is bowel incontinence?
Bowel or fecal incontinence is the inability to control bowel movements, resulting in the escape of stool from the rectum. The condition is more common in older people, but analysis shows that it can affect people from any age group. According to a report, more than 18 million US adults have bowel incontinence.
Bowel incontinence is caused by a number of health conditions, including
- Constipation: Constipation is characterized by hard, large stools. Watery stools build up behind the hard ones and may leak around causing incontinence.
- Diarrhea: Due to diarrhea, loose stools are produced which are difficult to hold back and may leak.
- Weak or damaged muscles: Surgeries and childbirth cause the muscles that keep the anus closed to become weak or damaged, causing leakage
The ICD 9 code for bowel incontinence is 787.6 which is not a billable code since it is further divided into 4 additional codes that define the condition in more detail. Further breakdown is thus:
787.60 Full incontinence of feces
787.61 Incomplete defecation
787.62 Fecal smearing
787.63 Fecal urgency
Conclusion
Correct and accurate coding is imperative for the timely and correct reimbursement of all medical claims. Having a thorough understanding of the ICD 9 code for incontinence and then applying it to the liable cases (before October 2015) can ensure that there are no coding errors when it comes to the coding for urinary incontinence. Still, have questions regarding correct coding? Reach out to the medical coding and billing experts at UControl Billing, with a proven record in outsourcing all your coding needs.
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