Urology Coding Alert

4 new renal pelvis catheter codes reflect emerging technologies

On Jan. 1, you'll have several new codes that you can use for your urology coding, including one for open cryoablation and one for renal ablation. The new codes better reflect the new technology urologists are using, and they will also keep you from having to use unlisted-procedure codes.

Avoid Unlisted-Procedure Code With 50250, 50592

CPT Codes 2006 adds two codes for the treatment of renal mass lesions:

• 50250--Ablation, open, one or more renal mass lesions(s), cryosurgical, including intraoperative ultrasound, if performed

• CPT 50592 --Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency.

The open cryoablation code, CPT 50250 , is a welcome addition, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. Before this new code, you had to report an open partial nephrectomy (50240, Nephrectomy, partial), which did not correctly reflect the true technique, or an unlisted-procedure code, CPT 53899 (Unlisted procedure, urinary system).

Tip: 50592's descriptor specifies unilateral, so if your urologist performs the procedure on both sides, you should append modifier 50 (Bilateral procedure) to indicate that the procedure was bilateral.

Also, the descriptor has no intraoperative radiological inclusions, so you can separately report radiological monitoring during the surgery. For example, if your urologist uses a computed tomography (CT) scan for location and monitoring of the tumor's response to the percutaneous radiofrequency, you should report 76362 (Computed tomography guidance for, and monitoring of, visceral tissue ablation).

If your urologist uses magnetic resonance imaging (MRI), report 76394 (Magnetic resonance guidance for, and monitoring of, visceral tissue ablation), and if he uses ultrasound, report 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation).

Don't overlook: For percutaneous cryotherapy ablation that you report after Jan.1, you'll use Category III code 0135T (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy).

4 Stent Codes Offer Better Options for New Technology

You have four new codes to use for the removal or exchange of ureteral or nephroureteral stents:

• 50382--Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

• 50384--Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

• 50387--Removal and replacement of externally accessible transnephric ureteral stent (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

• 50389--Removal of nephrostomy tube, requiring fluoroscopic guidance (e.g., with concurrent indwelling ureteral stent).

The four new codes reflect new technologies, Hause says. Prior to the 2006 CPT changes, you haven't had appropriate codes to report these types of procedures.
 
Bonus: When your urologist percutaneously removes and replaces an indwelling ureteral stent on both sides, you can report 50382 and append modifier 50 (Bilateral procedure).

Note: "Urologists remove most nephrostomy tubes without guidance. In those cases, you should just report the appropriate E/M service," says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook. But when the physician needs to use fluoroscopic guidance, the procedure is technically more difficult, and you should report 50389. "Hopefully, in the future we'll have a code for the simple removal of a nephrostomy tube," Ferragamo says.

Prostatic Laser Procedure Codes Get an Update

CPT 2006 also revises the code descriptors on two laser codes for the treatment of benign prostatic hypertrophy (BPH), 52647 and 52648.

Old definition of 52647: Non-contact laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included).

New definition of 52647: Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed).

Old definition of 52648: Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included).

New definition of 52648: Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed).

"The modifications to 52647 and 52648 should make it easier to assign the correct codes when lasers are used on prostates," Hause says.

Strategy: When you are deciding between 52647 and 52648, base your decision on the major laser effect on the prostatic adenoma. If the major effect is coagulation, you should report 52647. If the major laser energy effect is primarily vaporization, use 52468, Ferragamo says.

CPT Also Adds a New Uro-Gynecological Code

In other CPT news, you'll want to take note of the following:

• New unlisted-procedure code 51999 (Unlisted laparoscopy procedure, bladder) will be available in 2006. You'll use this code for procedures such as laparoscopic bladder diverticulectomy, laparoscopic myomectomy for overactive bladder, or laparoscopic cystolithotomy, Ferragamo says.

You should correlate 51999 with a similar open procedure when you submit this unlisted-procedure code and indicate the payment you think you should receive.

• Another CPT 2006 edit solves the dilemma you face when your urologist changes a ureteral stent in an ileal conduit. Code 50688 changes from "Change of ureterostomy tube" to "Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit."

In the past, you have had to use 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) with modifier 52 (Reduced services) appended to indicate that the physician wasn't doing a cystoscopic examination to exchange the stents.

• You'll be able to report a new uro-gynecological code, 57295 (Revision [including removal] of prosthetic vaginal graft, vaginal approach), for the revision or removal of a prosthetic vaginal graft.

This new code is the opposite of existing code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach).

While there was a code for the revision of a sling procedure for stress urinary incontinence, the only way to report the revision of a vaginal graft was to use 58999 (Unlisted procedure, female genital system [nonobstetric]), says Melanie Witt, an independent coding consultant in Guadalupita, N.M. Now you can report 57295 instead of the unlisted-procedure code.