Urology Coding Alert

Familiarizing yourself with recent coding updates will be the key to a successful new year.

Over the past year, you’ve learned about newly introduced codes and a major change when it comes to coding for time during office/outpatient evaluation and management (E/M) visits. Read on to refresh your memory and avoid claim denials in 2024.

Question: Were there any new HCPCS Level II codes introduced in 2023 that I should be aware of?

Answer: The 2023 update to the HCPCS Level II codes includes four new codes related to renal pelvis catheter procedures. The difference is that the code descriptors for C7546-C7549 specifically include the ureteral stricture balloon dilation performed in the hospital outpatient and ambulatory surgical center settings. “This means that the new C codes should be used in the outpatient setting if ureteral dilation is performed in the removal/replacement, conversion from nephrostomy catheter to nephroureteral catheter, exchange of nephrostomy catheter, or change of ureterostomy tube or stent via ileal conduit,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland.

• C7546 (Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation)
• C7547 (Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dialation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)
• C7548 (Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)
• C7549 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)

“There are currently CPT Category I codes to describe the removal/exchange/ replacements of nephroureteral catheter, nephrostomy catheters, or ureterostomy tube or stent procedures without the ureteral balloon dilation. The new HCPCS codes were developed to include the use of the ureteral stricture balloon dilation,” says Storck.

Question: What were the important ICD-10 coding updates for 2023?

Answer: The most important change involves an expansion of the Y07.- (Perpetrator of assault, maltreatment and neglect) code group, and new codes in the “Persons with potential health hazards related to socioeconomic and psychosocial circumstances” (Z55-Z65) section.

Three of the new codes in particular could easily come into play in the urology setting:

• Z55.6 (Problems related to health literacy)
• Z91.141 (Patient’s other noncompliance with medication regimen due to financial hardship)
• Z91.148 (Patient’s other noncompliance with medication regimen for other reason)

Take note: The inclusion terms associated with the Z55.6 code include challenges in comprehending health-related information, issues with understanding instructions related to medication, and difficulties in filling out medical forms.

Question: What changes were made in 2023 related to E/M time coding and the prolonged service codes?

Answer: CPT^® has opted to eliminate the time ranges from both new and established office/outpatient E/M codes. Instead, it is substituting them with a single total time value, which corresponds to the lowest number of minutes currently in the range for each code. This time “must be met or exceeded” according to the new wording that now appears in each of the codes’ descriptors.

In table form, the changes look like this:

Essentially, “this doesn’t really change how the codes are used, but listing the minimum time instead of a range for each code is probably going to be easier to follow,” says Kelly Loya, CPC, CHC, CPhT, CRMA, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

What will happen to G2212? One possible result of this change may be the resolution to the dispute between CPT^® and Medicare over the prolonged service threshold. Basically stated, Medicare created their own code, G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure …), as AMA/CPT^® viewed prolonged services as beginning at the minimum time for 99205/99215 and CMS beyond the maximum. Now that the time ranges for 99205/99215 have been replaced by a threshold at the minimum end of the range, it is possible that Medicare may follow CPT^® rules and adopt +99417 (Prolonged outpatient evaluation and management service(s) time … each 15 minutes of total time …) for prolonged services instead.

CPT^® has also made one other slight change. This change applies to the nursing facility care codes 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient …) and 99307 (Subsequent nursing facility care …), raising their time thresholds by five minutes to 50 and 20 minutes, respectively. “It will be important for podiatric providers to know these new, higher thresholds if they are seeing patients in a nursing facility,” Loya notes.

In 2023, CPT^® removed the words “beyond the minimum required time” from the descriptor for +99417, which now reads (Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)).

For 2023, CPT^® also deletes prolonged service codes +99354 and +99355. In their place, you’ll now use +99417, as CPT^® has increased its scope.

Question: Were there any nephology ICD-10-CM updates made effective October 1, 2023?

Answer: ICD-10-CM continues its expansion of nephrology-related diagnoses by converting N04.2 (Nephrotic syndrome with diffuse membranous glomerulonephritis) and N06.2 (Isolated proteinuria with diffuse membranous glomerulonephritis) to parent codes and adding the following new codes beneath them, respectively:

• N04.20 (Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified)
• N04.21 (Primary membranous nephropathy with nephrotic syndrome)
• N04.22 (Secondary membranous nephropathy with nephrotic syndrome)
• N04.29 (Other nephrotic syndrome with diffuse membranous glomerulonephritis)
• N06.20 (Isolated proteinuria with diffuse membranous glomerulonephritis, unspecified)
• N06.21 (Primary membranous nephropathy with isolated proteinuria)
• N06.22 (Secondary membranous nephropathy with isolated proteinuria)
• N06.29 (Other isolated proteinuria with diffuse membranous glomerulonephritis)

“These codes were added to provide a more specific diagnosis for patients with nephrotic syndrome, and also proteinuria in different conditions. Nephrotic syndrome is a condition characterized by severe proteinuria, greater than 3.5 g/day in an average adult. Diseases associated with nephrotic syndrome generally cause chronic kidney dysfunction,” says Storck.