Urology Coding Alert

When the mayor of New York City, Rudolph Giuliani, announced that he had prostate cancer at the end of April, he sent a clear message to men across America to get screened for the disease. At the end of May, however, he was still mulling over his treatment options. In the interim, he has withdrawn from the Senate race and announced that he and his wife would be separating. An obviously turbulent month for the former prosecutor known as a man with a very stiff upper lip, the month was also, according to news reports, filled with discussions with his doctors about how to treat his cancer. How does a urologist code for all of the time involved in discussing the treatment options with a prostate cancer patient?

First of all, there is a lot of psychological support involved when a patient gets a cancer diagnosis. If over 50 percent of the time spent with the patient is for counseling, time then becomes the key component for selecting the level of evaluation and management (E/M) service, explains Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding, reimbursement and compliance consulting firm based in Denver. For example, if the urologist spends 10 minutes taking the history, doing the physical examination and performing medical decision-making, and then spends an additional 30 minutes on counseling the patient about treatment options, the risk of complications, the prognosis, and such, then the total time spent with the patient is 40 minutes, notes Page. This means that the urologist could bill a 99215 (established patient), 99204 (new patient) or 99243 (consultation) for such a visit, says Page, depending on how the patient presented. If it were Giulianis first visit, it would be 99204 or 99243; if a subsequent visit, it would be 99215.

Documentation is very important, as always. The documentation must include the time spent performing services and/or counseling the patient, says Page. There should also be a brief overview of what was discussed. Any psychological counseling done by the urologist should be reported with an E/M services code, says Page, noting that the level is determined by the total time spent.

There are a variety of treatment options for prostate cancer, which may be one reason it takes time for the urologist and patient to decide on one. Here are the codes:

55801-55845: prostatectomy
55859-55865: seed implantation
G0160 (Medicare only): cryosurgical ablation of localized prostate cancer, primary treatment only
(postoperative irrigations and aspirations of sloughing tissue included)
G0161 (Medicare only): ultrasonic guidance for
interstitial placement of cyosurgical probes
54530-54535: orchiectomy
Chemotherapy with LHRH agonists
J9217: Lupron
J9202: Zoladex
96400: chemotherapy administration (can be billed with E/M visit)

Note: For more on prostate cancer codes see the article Coding in the News: New York Mayor Giulianni Urges PSA Screening in the May issue of Urology Coding Alert.