Urology Coding Alert

Tip: A new code for e-visits may also be on the horizon

If your urologist is on the cutting edge of the technology boom, you face the daunting task of trying to code for electronic services he provides. Good news: In January your coding life may get easier with new telephone and e-visit codes.

Look Forward to Time-Based Codes

Proposed changes: Three new proposed codes for 2008 would allow you to report the telephone E/M services your urologist performs based on the length of the phone call. The current telephone service codes--99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...)--depend on the complexity level of the call.

Now you're forced to decide if the call is simple, intermediate or complex to be able to choose a code. With the new codes, you can eliminate that decision. CPT 2008 will delete existing CPT telephone codes 99371-99373 and replace them with the three new time-based codes and one online E/M service code.

Note: The telephone call is a non-face-to-face E/M service and must emanate only from an established patient and have no relationship within seven days of a recent previous visit, surgical or diagnostic procedure, or a scheduled upcoming E/M service. CPT considers these part of a previous or an up-coming visit and billable in the subsequent E/M code chosen.

"I think that time-based reporting versus trying to determine what is 'simple,' 'intermediate' or 'complex' is definitely a good thing," says Denae M. Merrill, CPC, physician coder for Covenant HIM in Saginaw, Mich. "You then have a clear-cut definition of what is what, a provider will then know what is important to document, and a coder will know what code is most appropriate and there will be no room for arguing."

Watch for 0074T Elimination

Additionally: Right now you have a Category III code, added in 2005, to recognize e-visit services--0074T (Online evaluation and management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient). Since this type of service isn't considered "emerging technology" anymore, experts are expecting the deletion of 0074T in 2008. That code should be replaced with a Category I  e-visit code for you to start reporting in January.

Warning: Just because you have new codes, that doesn't mean Medicare or other carriers will pay. "New codes, or codes that are transitioned from Category III to Category I, do not mean more reimbursement," Merrill says. "It often takes the payer community time to get on the bandwagon and start reimbursing. Even then, you may find they will create guidelines to limit reimbursement to specified criterion only."

You'll have to wait until the 2008 Medicare Physician Fee Schedule comes out to see if CMS assigns relative value units (RVUs) and a fee to the Category I e-visit code. "There are a number of codes that are present in the CPT or HCPCS Manual that do not have any reimbursement attached to them," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies in Powder Springs, Ga.

Remember: None of these changes are official until the CPT book comes out in November.