Urology Coding Alert

Plus: Learn how to incorporate 2007's renumbered codes

For urology coders, the 2007 CPT revisions will bring several clarifications that will help make your job easier. You'll have a clear answer on how to report multiple biopsies via cystourethroscopy, and your search for tricky procedures, such as exploration of the epididymis, just got easier.

Take a look at the changes you'll need to focus on come Jan. 1 to keep your urology practice on track.

Watch Out for the New 'S'

A urologist performing multiple biopsies during a cystourethroscopy used to be a coding nightmare ¾ but not anymore. CPT Codes 2007 clarifies how you should report these multiple biopsies. Starting Jan. 1, you should report 52204 (Cystourethroscopy, with biopsy[s]) just once.

In the past, you could report each separate biopsy using CPT 52204 multiple times, and many carriers would pay on each one, experts say. That won't be the case anymore.

What changed: What seems like a very minor change -- the addition of "(s)" -- actually has a large impact on how you might code these types of procedures. Regardless of the number of biopsy sites or how many biopsy specimens your urologist obtains, you'll report one instance of 52204.

"The change of the text for 52204 makes a long disputed issue clear," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis. "The addition of (s) to 52204 solves a long disputed issue about the use of this code multiple times for multiple biopsy sites."

Tip: If your urologist performs a significant number of biopsies due to the nature of the procedure, you may be able to report 52204 with modifier 22 (Unusual procedural services) to show that the physician spent extra time and effort on the procedure.

Use 55876 for Fiducial Markers

One of the most positive additions for urology coders is new code 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple).

This new code is necessary because urologists are already performing the relatively new procedure of placing markers in the prostate to facilitate radiation therapy to the prostate. Previously, you had to use an unlisted code to report this procedure (55899, Unlisted procedure, male genital system).

"I am assuming we'll be able to utilize this code for our gold seed placements, and what a relief that will be!" says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind.

"CPT 55876 is a very welcome addition!" Hause says. "We are anxious to see how much is reimbursed." In New York, area #2, Medicare will reimburse $170.78 when the urologist performs the procedure in the office and $124.15 when performed in the hospital, inpatient or outpatient. Check with your particular carrier's Web site for payments in your state and/or county.

Add 57296, 58541-58544 to Your Arsenal

If your urologist has to use a transabdominal approach to remove a prosthetic vaginal graft, starting Jan. 1, you'll have a specific code to report this procedure -- 57296 (Revision [including removal] of prosthetic vaginal graft; open abdominal approach). "We've needed this code for some time now," says Nina Mutone, MD, medical director of the urogynecology division at St. Vincent's Hospital in Indianapolis.

You already had a code for the vaginal removal of a prosthetic vaginal graft (57295, Revision [including removal] of prosthetic vaginal graft; vaginal approach), and now you have an additional code to reflect another surgical approach.

Urogynecology additions: If your urologist performs urogynecological procedures, you'll be glad to see new codes 58541-58544 (Laparoscopy, surgical, supracervical hysterectomy ...). In the recent past some urogynecologists have performed supracervical hysterectomies via a laparoscopic approach, and since there was no specific CPT code to report this procedure, you had to report the procedure with unlisted code 58578 (Unlisted laparoscopy procedure, uterus).

Which CPT code you'll now report depends on the size of the uterus the urologist removed (greater than or less than 250 grams) and whether the physician also removed tube(s) and/or ovary(s).

Take Advantage of Re-Organization

CPT 2007 brings you several renumbered procedure codes. These are codes where the descriptors have remained the same but the numbers have changed. The renumbered codes urology coders need to learn are:

• 54865 -- Exploration of epididymis, with or without biopsy, replaces 2006 code 54820.

• 55875 -- Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy, replaces 2006 code 55859.

• 76998 -- Ultrasonic guidance, intraoperative, replaces 2006 code 76986.

Why they moved: According to coding experts, the reason CPT renumbers codes is to put the procedure listings in a more logical place in the CPT manual. This clarifies the type of code you're referring to and should make it easier for you to find the appropriate procedure code.

For example, 54865 falls under the Epididymis > Exploration section of codes, whereas the previous code, 54820, was categorized under the Epididymis > Excision section.