Urology Coding Alert

Updates help clarify what codes truly represent.

Urology coders will only have one new addition to CPT^® 2018 to learn for the new year, but multiple revisions to get familiar with for day-to-day reporting. Here's a look at changes to your specialty, with explanations from our experts.

Say Hello to 0499T

The new urology addition is a Category III code, meaning it's a temporary code that represents an emerging technology, service, or procedure. Your new option will be 0499T (Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed).

Remember: Category III codes are in place for data collection purposes. If a Category III code is available for the procedure you're coding, you must submit it instead of an "unlisted" Category I procedure code.

Check payment: Also remember that Category III codes do not have assigned RVUs. Payment is based on individual payer policies, so check with your insurers about reimbursement rates.

Incorporate 8 New and Revised Codes

CPT^® 2018 will include urology-related revisions for several types of services. Three represent procedures quite common to your practice:

"CPT^® code changes starting Jan. 1, 2018, are mostly nominal in nature, associated with some clarifications for the majority of the procedures," says Jonathan Rubenstein, MD, compliance officer and medical director for coding and reimbursement with Chesapeake Urology in Baltimore, Md. "As you can see by the new descriptors, codes 57240, 57260, and 57265 all clarify that cystourethroscopy, if performed, are included in the procedure code, and not separately billable."

Fluoro change: Fluoroscopy code 76000 will also see revision for 2018. The new descriptor will still represent up to an hour of fluoroscopy time, but will be much shorter. The new wording will be, "Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time."

"Codes 99217, 99218, 99219, and 99220 have some wording changes to clarify the definition of observation status as being in a hospital but in the outpatient setting of a hospital," Rubenstein explains. "This is used to help further differentiate a true 'inpatient' hospital stay, to reduce confusion for proper coding of services rendered."

Two Deletions Lead to Better Accuracy

You will lose two urology codes on Jan. 1 – one Category I, and one Category III – but the changes to your coding will be minimal. You will no longer report:

• 55450 – Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)
• 0438T – Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance.

"CPT^® 55450 was eliminated to reduce confusion and ensure accurate coding," Rubenstein says. "Vasectomy has been coded and should continue to be coded using CPT® code 55250. This is how I have always coded for a vasectomy, and how I have taught others to code."

Also note: The temporary Category III code 0438T was eliminated due to the creation of the Category I code 55874 (Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed), notes Michael Ferragamo MD, FACS, clinical assistant professor of urology, State University of New York, University Hospital and Medical School, Stony Brook, NY. Code 55874 will be activated Jan. 1, 2018.

The remaining four revisions apply to observation care.