Urology Coding Alert

Experts expect you'll see slightly lower payments with the new drug admin codes

If your urologist administers Zometa or Lupron injections, you’ll need to change how you report them when CPT 2006 replaces temporary G codes G0347, G0351 or G0356 with permanent CPT Codes on Jan. 1. The new codes will streamline how you report drug administrations to both Medicare and private carriers, but you’ll see lower reimbursement as well.

You’ll Have Fewer Codes to Deal With

You’ll have fewer codes to worry about with the deletion of the three drug administration G codes. “With the elimination of these G codes, it will be more convenient for the urology coder to have one set of codes that apply to both Medicare and private insurance,” says Barbara Doll, RN, CPC, coding manager for Healthcare Information Services in Willowbrook, Ill. (Refer to “Get to Know Your New Drug Administration Codes” later in this issue to learn more about the new codes.)

“It is easier to have only one code that all carriers acknowledge for the same service,” agrees Karen Delebreau, CPC, coder with BayCare Clinic Urological Surgeons in Green Bay, Wis. “There is already enough diversity in policies, modifiers, etc., amongst carriers. A small step in the right direction is welcome.”

What the New Codes Mean to Payment

In general, urologists will be paid about 7 percent less than last year when using the new administration codes. For example, based on the 2005 and 2006 Physician Fee Schedule, instead of a $36.69 reimbursement for G0356, you’ll receive about $34.01 for code 96402 in 2006, which is about 7.3 percent less.
 
Note: This calculation is based on the loss of the 3 percent transitional increase that physicians received in 2005, but that’s being discontinued in 2006; the change in the conversion factor; minor changes in the relative value units (RVU); and the geographic practice cost indices (GPCI).