Radiology Coding Alert

You'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.

Many 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.

In addition to changing how you code ureteral stent removal, CPT 2008 will change how you code renal tumor ablation. Say goodbye to temporary code 0135T (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy). January's changes delete this code and replace it with 50593, which has the same descriptor.

"I am glad they are getting a code for this," Shanley says. For 2007 services, her office usually collected an advance beneficiary notice (ABN) form from patients before performing a cryotherapy renal tumor ablation.

"Only a small portion of our contracted payers pay for 0135T, and Medicare never pays it," says Maryann Ward, a coder with Johns Hopkins University in Baltimore. The 2008 Medicare Physician Fee Schedule lists 9.08 RVUs for this code.

How to use 50593: As the descriptor states, 50593 is for unilateral ablation. For bilateral procedures, CPT 2008 instructs you to append modifier 50 (Bilateral procedure).

Different payers have different requirements for reporting bilateral procedures, so be sure to follow your payer's preference.

You should not report moderate sedation separately for this service, but you may report imaging guidance for 50593 separately with the following codes:

• 76940 -- Ultrasound guidance for, and monitoring of, parenchymal tissue ablation

• 77013 -- Computed tomography guidance for, and monitoring of, parenchymal tissue ablation

• 77022 -- Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation.

Choose the appropriate code based on the modality the physician uses (ultrasound, CT or MRI).

Code 50593 is specific to renal tumors, which means you're likely to perform this procedure for patients with the following diagnoses, according to CPT Changes 2008:

• 189.0 -- Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis

• 189.1 -- ... renal pelvis.