Documenting Pyelonephritis – A Common Urinary Tract Infection

by | Published on Jan 12, 2021 | Medical Coding

Share this:

Regarded as a common type of urinary tract infection (UTI), pyelonephritis generally begins in the urethra or bladder and moves upstream to one or both the kidneys. In most cases, bacteria infect the bladder or the urethra and spread to one of the kidneys. The condition typically occurs when bacteria is not flushed out of the body along with the urine. Also known as kidney infection, the condition causes the kidneys to swell thereby permanently damaging them. According to reports from ClevelandClinic.Org, the disease occurs roughly among three to seven of every 10,000 people (2019 statistics) in the United States. In fact, the occurrence is more common among women, particularly pregnant women – that is, about 2 percent. It can also occur in children below 2 years of age and individuals above 60 years. Pyelonephritis or kidney infection requires prompt medical attention. If left untreated, the condition can permanently damage the kidneys or the bacteria can spread to the bloodstream, causing serious and life-threatening infection. In most cases, treatment for kidney infections involves oral antibiotics. Diagnosing, and documenting common types of urology infections can be a complex task for physicians. Accurate and specific medical record documentation is vital for correct billing and coding for urology conditions like pyelonephritis. With appropriate documentation, urology medical billing and coding companies can help physicians select the correct ICD-10 codes and file clean claims for adequate reimbursement.

In most cases, a bacterium called E Coli (Escherichia Coli) causes about 90 percent of kidney infections. The bacterium normally moves from the genitals through the urethra (the tube that removes urine from the body) into the bladder and up the tubes (ureters) that connect the bladder to the kidneys. In some rare cases, bacteria from an infection elsewhere in the body can also spread through the bloodstream into the kidneys. Generally, pyelonephritis can be of two different types – acute and chronic. Acute pyelonephritis is a sudden and severe kidney infection that causes the kidneys to swell and may permanently damage them. Chronic pyelonephritis, on the other hand, occurs when repeated or persistent bacteria attacks occur. However, the chronic form is very rare and it occurs more often in children or people with urinary obstructions.

Understanding the Symptoms and Risk Factors

Generally, a person with kidney infection develops signs and symptoms quite fast – within a day or two (after developing the infection). Common symptoms include – diarrhea, vomiting, uncontrollable shivering, pain in the side, burning sensation or pain when urinating, pain in the groin, nausea and back pain. In most cases, these symptoms become worse when patients urinate. If a bladder infection occurs along with pyelonephritis, the patient may experience other related symptoms like – pus or blood in the urine (hematuria), urine that smells bad or is cloudy, frequent urination, inability to urinate fully and pain in the lower abdomen.

However, several problems can increase the risk of a kidney infection. These include – structural abnormalities (strictures, stents, stones, surgery) blocking urine flow, uncontrolled diabetes mellitus, pregnancy, backflow (reflux) of urine from the bladder to the kidneys and an enlarged prostate gland (benign prostatic hyperplasia) compressing the urethra.

Diagnosing and Treating Kidney Infections

Diagnosis of this condition may generally begin with a physical examination; with particular emphasis on the mid- and lower- back area to check whether there is any sensitivity, pain, or tenderness. Physicians will usually check the patient’s heart rate, blood pressure, temperature, and respiratory rate to check their general state of health. They will also check for other signs of dehydration.

To make an accurate diagnosis, patients will be asked to provide a urine sample to test for the presence of bacteria, blood or pus in the urine. Urologists may also take a blood sample for a culture (a lab test that checks for bacteria or other organisms in the blood). If the patient is a young woman, the physician may carry out a pelvic exam to verify whether there is any pelvic inflammatory disease (PID). If the female is of childbearing age, a pregnancy test may be recommended. Imaging tests like Ultrasound, CT scan or a type of X-Ray called “A voiding cystourethrogram” (involves injecting a contrast dye to take X-rays of the bladder when full and while urinating) may be requested. In addition, a dimercaptosuccinic acid (DMSA) test may be ordered if the doctor suspects scarring as a result of pyelonephritis.

Antibiotics are the first line of treatment for kidney infections. Usually, the signs and symptoms of a kidney infection begin to clear up within a few days of treatment. However, patients may need to continue antibiotics for a week or longer. Antibiotics options include – levofloxacin, ciprofloxacin, co-trimoxazole and ampicillin. It is important for patients to consume the entire course of antibiotics as recommended by the urologist. In some cases, urologists may also recommend a repeat urine culture to ensure whether the infection has cleared. If the infection is still present, patients need to take another course of antibiotics.

If the kidney infection is severe, the patient may be admitted to the hospital. The length of stay in the hospital depends on the severity of the condition and how well the patient responds to the treatment. Treatment may include antibiotics and fluids through a vein in the arm (intravenously). For recurrent kidney infections, surgery may be a recommended option. Surgery may be performed to remove any obstructions or to correct any structural problems in the kidneys. The procedure may also be performed to drain an abscess that doesn’t respond to antibiotics. In some cases of severe infection, a nephrectomy may be necessary. In this procedure, the surgeon removes part of the kidney. All diagnostic tests and other procedures performed need to be documented using the correct medical codes. Medical billing and coding services provided by medical billing companies can help physicians use the correct codes for their medical billing process. ICD- 10 codes to diagnose pyelonephritis include –

  • N10 Acute pyelonephritis
  • N11 Chronic tubulo-interstitial nephritis
  • N11.0 Nonobstructive reflux-associated chronic pyelonephritis
  • N11.1 Chronic obstructive pyelonephritis
  • N11.8 Other chronic tubulo-interstitial nephritis
  • N11.9 Chronic tubulo-interstitial nephritis, unspecified

Pyelonephritis can be a serious, life-threatening condition and hence requires prompt medical attention. So, the earlier a person starts treatment, the better will be the outcome. One of the best ways to prevent a kidney infection from developing is by not having bacteria in the urethra or bladder. Other common prevention tips include – drinking plenty of fluids to increase urination and removing bacteria from the urethra, wiping from front to back after urinating, emptying the bladder after intercourse, avoiding delay in urination, and avoiding using products that can irritate the urethra, such as douches or feminine sprays.

For correct and timely billing and claims submission, healthcare practices can rely on medical billing and coding companies that provide the services of AAPC-certified coding specialists for all billing and coding tasks.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

More from This Author


Submit a Comment

Your email address will not be published. Required fields are marked *