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 [...]