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Learn about the different neurogenic bladder types.

Neurogenic bladder is a urologic condition where the nerves between the bladder and spinal cord and brain do not work the way they should. The condition develops due to several other factors at play in the body.

Get to know this urologic condition and learn what codes to assign for proper reimbursement.

Nail Down Neurogenic Bladder Knowledge

Messages carried by the nerves tell the bladder muscles to either tighten (to retain urine) or release (eliminate urine). Depending on the nerves involved and the nature of the damage, the bladder can become either overactive or underactive. This can be due to nerve problems in the brain or spinal cord and can be caused by injuries, infections, poisoning, surgery, stroke, chronic health conditions (diabetes, herniated disc), and neurological conditions such as Parkinson鈥檚, multiple sclerosis, transverse myelitis, cerebral palsy, spina bifida, or dementia.

Common symptoms of neurogenic bladder include:

• Urinary tract infection (UTI)
• Kidney stones
• Incontinence
• Dribbling of urine
• Loss of feeling that bladder is full
• Frequent urination
• Urgency (feeling or need to urinate immediately)
• Only urinating a small amount at a time
• Urinary leakage

Find Out About the Types of Neurogenic Bladder

There are diverse ways to identify the types of neurogenic bladder, categorized by the urination difficulty caused. The bladder can either be categorized as an overactive bladder, underactive bladder, or a combination of both. The conditions are broken down into five separate types: sensory, motor paralytic, uninhibited, reflex, and autonomous.

Sensory neurogenic bladder: This condition occurs when the bladder and nerve communication have been interrupted by damage to fibers in the sensory nerves of the bladder or brain. Sensory neurogenic bladder can be caused by conditions, such as diabetes and anemia, and can lead to chronic bladder swelling and an underactive bladder.

Motor paralytic neurogenic bladder: This condition is caused by the loss of function in specific nerves that allow communication between the bladder and brain. This can be caused by surgery, traumatic injury, and a complication of shingles that can cause bladder swelling and incomplete bladder emptying.

Uninhibited neurogenic bladder: This condition is caused by damage to the brain or the spine as a result of a stroke, brain tumor, or spinal lesions leading to urinary frequency, urinary urgency, and urine leakage.

Reflex neurogenic bladder: This condition is caused by difficulty with nerves in the upper spine as a result of a spinal cord injury, spinal cord disease, transverse myelitis, or an extensive demyelinating disease. The nerve issues can lead to lack of control over bladder contractions and loss of sensation of bladder fullness.

Autonomous neurogenic bladder: This condition is due to damage to both the motor and sensory nerves controlling the bladder. As a result, the patient can experience conditions such as problems with pelvic nerves or sacral spinal cord, as well as loss of ability to control urine and a loss of sensation of bladder fullness.

Pick Out the Correct Procedure Codes

Assign CPT^庐 procedure codes based on what was done for the patient. Evaluation and management (E/M) codes are used for office visits, while specific procedure codes are reported for images, diagnostic procedures, and surgeries performed.

Examples of diagnostic procedures used to identify neurogenic bladder include:

• X-rays of the spine and skull:
  • 70250-70260 (Radiologic examination, skull 鈥�)
  • 72020-72120 (Radiologic examination, spine 鈥�)
• Ultrasound of bladder and ureters to identify changes in the structures of the bladder and ureters
• Cystoscopy to identify bladder structure changes or blockages, such as tumors or calculus:
  • 52204 (Cystourethroscopy, with biopsy(s))

• Urodynamics testing to measure how much urine the bladder can hold and if the bladder is fully emptying:
  • 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging)

Examine Different Treatment Options

There is no cure for neurogenic bladder, but there are several options to manage the condition. Lifestyle changes to avoid certain foods or drinks that irritate the bladder can be implemented. The urologist can prescribe medications to treat neurogenic bladder such as antibiotics to reduce infections. Another medication used to help with neurogenic bladder is the injection of Botulinum toxin (Botox) shots into the bladder muscle to keep it from contracting. Patients can be taught to empty the bladder with intermittent catheters at certain times. Electrical stimulation can also be placed to stimulate or slow down bladder activity.

Surgery is also an option to enlarge the bladder, remove portions of the sphincter muscles, or create an ileal conduit to a stoma to drain urine in a bag attached to the outside of the body.

A urologist may also perform a bladder augmentation where segments of the intestine are removed and attached to the walls of the bladder.

Dig Into Neurogenic Bladder Diagnosis Codes

In the 鈥孖CD-10-CM diagnosis coding鈥� system, neurogenic bladder is classified under the N31.- (Neuromuscular dysfunction of bladder, not elsewhere classified) category, specifically with N31.8 (Other neuromuscular dysfunction of the 鈥宐ladder) and鈥� N31.9 (Neuromuscular 鈥媎ysfunction of the bladder, unspecified). For a neurogenic bladder diagnosis, assign N31.8 unless there are other manifestations that require different ICD-10-CM codes, or there is no specific condition that can be identified.

These codes are used to specify the type of neurogenic bladder and are important for accurate diagnosis and treatment. In the ICD-10-CM code book, neurogenic bladder is further subcategorized 鈥媌ased on the specific 鈥島nderlying cause or鈥� contributing factors. These subcategories include but are鈥� not鈥� limited to:

• N31.0 (Uninhibited neuropathic bladder, not elsewhere classified)
• N31.1 (Reflex neuropathic bladder, not elsewhere classified)
• N31.2 (Flaccid neuropathic bladder, not elsewhere classified)

The ICD-10-CM classification system鈥� also features more specific codes for neurogenic bladder depending on鈥� the underlying cause, such as multiple sclerosis 鈥�(G95.8-, Other specified diseases of spinal cord), spinal cord injury (G95.89, Other specified diseases of spinal cord), or other 鈥宻pecified disorders of the nervous 鈥峴ystem (G97.8-, Other intraoperative and postprocedural complications and disorders of nervous system).

Use the ICD-10-CM diagnosis code that appropriately describes the condition, the underlying cause, and any specific manifestations of the condition.

Don鈥檛 Forget These 3 Documentation Tips

As a urology coder, having the correct documentation will help back up your claim, so the urologist can receive proper reimbursement. Check out these documentation tips to help your claim succeed:

Tip 1: The physician should document the underlying cause of 鈥宼he neurogenic bladder such 鈥媋s鈥� spinal cord injury, multiple sclerosis, or diabetes, as鈥� this may impact code selection.

Tip 2: Code selection 鈥媘ay vary based on the type of鈥� neurogenic bladder (i.e., flaccid, spastic, 鈥峯r鈥� mixed).

Tip 3: Don鈥檛 forget to assign additional codes for鈥� any associated complications, such as urinary tract 鈥媔nfections or urinary retention.

By utilizing specific codes for different manifestations 鈥媋nd etiologies of鈥� neurogenic bladder, medical practitioners can ensure proper treatment and management of this condition.

Additionally, the ICD-10-CM coding system allows for robust data collection and 鈥峚nalysis, which is crucial鈥� for research and epidemiological studies 鈥宺elated to neurogenic bladder and its associated comorbidities.

Stephanie N. Stinchcomb Storck, CPC, CPMA, CUC, CCS-P,
longtime urology coding expert, Summerfield, Florida