Hematúria na infeção urinária

"Só codifico a hematúria nas Infecções urinárias, quando existe evidência escrita de que existiu hematúria. 
 Muitas vezes existem registos de urina II, com Hb+, ou os próprios colegas escrevem Hb+ na urina, 
 neste casos, não considero existir ITU com hematúria."

(Responde Fernando Lopes)
 
Se os exames de urina tipo II, com Hb+, não forem acompanhados do registo de hematúria esta não deveria ser codificada.

Para saber se a hematúria na infeção urinária, pode ou não ser codificada, vejamos as Guidelines:
4. Signs and symptoms
Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) contains many, but not all, codes for symptoms.
See Section I.B.18 Use of Signs/Symptom/Unspecified Codes
5. Conditions that are an integral part of a disease process
Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
6. Conditions that are not an integral part of a disease process
Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.
(ICD-10-CM Official Guidelines for Coding and Reporting, FY 2019, Page 14 of 120)
 
Assim, se em 75% dos casos de infeção urinária existem disúria, frequência urinária e urgência  (https://emedicine.medscape.com/article/231574-clinical), pode codificar-se a hematúria por não ser integrante do diagnóstico.
 
Por outro lado a lista tabular continua a incluir, numa das notas mais extensas da ICD-10-CM, a seguinte observação:
 
The conditions and signs or symptoms included in categories R00-R94 consist of:
...
(f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.
Chapter 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
 
 
Fernando Lopes