Urology Coding Alert

Plus: Look for new therapeutic installation and pelvic-floor repair codes

Your days of not having a code to report treatment of Fournier's gangrene will be over on Jan. 1, 2005. That's when the new batch of CPT Codes will take effect, which include codes for debridement of subcutaneous skin for necrotizing soft-tissue infection on the external genitalia, perineum and abdominal wall.

You'll find three new debridement codes in the 2005 CPT Manual:

 11004 - Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum

 11005 - Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure

 11006 - Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure.

These new codes will be a welcome sight for coders who previously had to use codes from the 11040-11044 series (Debridement; skin ...) to report Fournier's treatment, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 21-urologist practice in Indianapolis. At a recent conference, the American Urological Association advised that "these codes are paid better than the other debridement codes and have no global periods," Hause says. "Previously, providers were really not paid appropriately for these procedures, which are typically very involved and time-consuming."

Unlock Reimbursement With This CPT & ICD-9 Combo

The ICD-9 Code for Fournier's gangrene is 608.83 (Other specified disorders of male genital organs; vascular disorders). Report gangrene of the scrotum with 608.4 (Other inflammatory disorders of male genital organs).

Beware: "The problem is if you bill the new debridement codes with these ICD-9 Codes, several carriers - including Medicare - will not pay you," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York in Stony Brook. "They're not now linked as payable codes for the debridement, although they may be in the future."

Money Maker: As a primary diagnosis, report 785.4 (Gangrene). Report 608.83 or 608.4 as a secondary diagnosis.

CPT 2005 will also include a new add-on code, +11008 (Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection [list separately in addition to code for primary procedure]). Since this is an add-on code, you would bill it without a modifier and without reducing the charge, says Christina Duenas, CPC, coder for Foxhall Urology in Washington, D.C.

Check Out This New Upper Tract Instillation Code

Code 50391 (Instillation[s] of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube [e.g., anticarcinogenic or antifungal agent]) will provide a way to report topical immunotherapy - the installation of chemotherapeutic agents like BCG or mitomycin-C into the upper urinary tract, Ferragamo says. "This is one we've needed for a while," he says. "Urologists are increasingly doing upper tract installations as part of a conservative management program for ureteral and renal pelvic tumors." Typically, urologists use topical immunotherapy as an alternative to nephroureterectomy. For example, if a patient has only one kidney, a urologist might infuse BCG through a catheter into the upper urinary tract in the hope of destroying the cancer threatening the remaining kidney.

Strengthen Pelvic-Floor Reinforcements With 57267

Urogynecologists will find a new code under the "Vagina; Repair" section in the 2005 CPT manual to help with reporting extensive vaginal pelvic-floor repairs. Use code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [list separately in addition to code for primary procedure]) when the urogynecologist reinforces vaginal repairs with mesh, fascia or other prosthetic material.

"In 2005, you can charge separately for each separate reinforced repair," Ferragamo says. You may bill this code for each compartment - anterior, posterior or both - reinforced with a mesh or other materials. If the urologist reinforces both compartments, you may bill the code twice, Ferragamo says.

Remember: Since this is an add-on code, it won't require a modifier or fee reduction. You may not bill 57267 alone; you can only add it on to 45560 (Repair of rectocele [separate procedure]) or colporrhaphy codes 57240-57265 based on CPT guidelines, Ferragamo says.

The 2005 CPT manual will also include a new temporary Category III code, 0084T (Insertion of a temporary prostatic urethral stent).

Say Farewell to Radioactive Insertion Codes

Four endoscopic techniques for inserting radioactive substances - "old techniques no longer in common use," Hause says - will not appear in CPT 2005. The deleted codes are:

 50559 - Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with insertion of radioactive substance with or without biopsy and/or fulguration

 50578 - Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with insertion of radioactive substance, with or without biopsy and/or fulguration

 50959 - Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with insertion of radioactive substance, with or without biopsy and/or fulguration (not including provision of material)

 50978 - Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropy-elography, exclusive of radiologic service; with insertion of radioactive substance, with or without biopsy and/or fulguration (not including provision of material).

Note: For more CPT 2005 changes, see "Code Kidney Transplant Preparations More Accurately".