Medicare Compliance & Reimbursement

No cystoscopy? No problem next year

Good news: You can stop using the 52 modifier when your physician removes an internally dwelling ureteral stent without cystoscopy.

Old way: Currently, when the physician removes a ureteral stent without cystoscopy, you use stent removal code 52310 with the 52 modifier (Reduced services), says Christy Shanley, billing manager for the University of California, Irvine Dept. of Urology.

New way: CPT 2008 adds two new codes for ureteral stent removal via snare/capture without cystoscopy: 50385 (including stent replacement) and 50386 (without stent replacement).

Say goodbye to experimental code: CPT 2008 deletes Category III code 0135T (Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy) and replaces it with 50593, which has the same descriptor.

"I am glad they are getting a code for this," says Shanley.

Her office usually collects an Advance Beneficiary Notification (ABN) form from patients before the physician performs a cryotherapy renal tumor ablation.

"Only a small portion of our contracted payors pay for 0135T," says Maryann Ward, a coder with the Dept. of Urology of Johns Hopkins University, "and Medicare never pays it."

Some patients can't undergo an open renal tumor ablation because of comorbidities, she notes. She hopes Medicare will cover the procedure now that it has a Category I code.

More urology changes: You'll also have a new code for laser enucleation of the prostate (52649). You'll probably use this code with the "green light laser," says Shanley.

Another new CPT code will cover the placement of needles or catheters into pelvic organs for subsequent radiotherapy (55920).

Also, CPT 2008 revises the descriptor for voiding pressure studies code 51797 to clarify that you should list it separately in addition to a primary procedure. And January's update deletes 52510 (Transurethral balloon dilation of the prostatic urethra).