Radiology Coding Alert

At last -- a 2008 code that allows you to report RS&I separatelyYou'll find reporting urological procedures even easier in the new year. CPT offers new Category I CPT codes that have the specifics you need to quickly choose the proper stent removal and ablation codes. Here's what you need to know now.CPT Responds to Need for More Specific Ureteral Stent CodeMany interventional radiologists perform ureteral stent removal and replacement. Good news: CPT 2008 provides a specific code for transurethral removal of an internally dwelling ureteral stent without cystoscopy.2007 method: Previously, you had no specific code for this procedure. Some providers reported unlisted-procedure code 53899 (Unlisted procedure, urinary system). Others reported the endoscopic stent removal code 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) with modifier 52 (Reduced services), says Christy Shanley, CPC, billing manager with the University of California, Irvine. The other option has been to report only an E/M service code.2008 method: CPT 2008 adds two new codes for transurethral removal of ureteral stent via snare/capture without cystoscopy:• 50385 -- Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation• 50386 -- Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation.Watch out: You shouldn't use the codes when the physician removes a stent by an attached thread or string, says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook. That type of removal would be part of your E/M service for that visit, he says. When the physician uses a clamp or other instrument passed through the urethra to grasp the stent (which protrudes into the bladder) for removal or exchange, you'll use the new codes.RS&I: The new CPT codes include radiological supervision and interpretation (RS&I), Ferragamo says. So you should not report a separate code for radiological guidance with these services.And because physicians always perform these procedures under moderate sedation, you should not report moderate sedation separately in the facility setting, according to the AMA's CPT Changes 2008: An Insider's View. The inclusion of RS&I and moderate sedation keeps 50385 and 50386 in line with percutaneous internally dwelling ureteral stent removal and replacement codes 50382 and 50384, which CPT added in 2006.Also, Correct Coding Initiative version 14.0, effective Jan. 1, bundles 50386 (removal) into 50385 (removal and replacement), clarifying that if the physician removes and replaces a stent, you should only report 50385. For additional edits, see "Get a Sneak Peek at Radiology CCI 14.0 News" on page 27.Ablation Makes Crucial Cat. I/Cat. III SwitchIn addition to [...]