Urology Coding Alert

Plus, you may finally get paid for cryotherapy renal tumor ablation

January is a time to implement new and revised CPT Codes, and urology practices will have a lot to digest this year, including new stent removal codes and bladder aspiration code changes.

Don’t delay: One of the biggest changes for urology coders is that you’ll have two codes for stent removals without cystoscopy. Also, there is now a permanent code for cryotherapy renal tumor ablation, and there are new numbers for bladder aspiration. These new codes take effect on Jan. 1, and CPT expects coders to start using them right away. Remember that there is no longer a grace period for you to get used to the new codes.

No Cysto? No Problem Next Year

Good news: Beginning in January, you can stop using modifier 52 (Reduced services) when your urologist removes an internally dwelling ureteral stent without cystoscopy.

Old way: Now, when the urologist removes a ureteral stent without cystoscopy, you use stent removal code 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) with modifier 52, says Christy Shanley, CPC, billing manager for the University of California, Irvine, department of urology. The other option has been to report only an E/M service code.

New way: CPT 2008 adds two new codes for ureteral stent removal via snare/capture without cystoscopy: 50385 (Removal [via snare/capture] and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation) and 50386 (Removal [via snare/capture] of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation).

Do not use the codes when the urologist is removing a stent by means of an attached thread or string, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. "This would be part of your E/M service for that visit," he says. When the physician uses a clamp or other instrument passed through the urethra to grasp the stent and facilitate its removal or exchange, you’ll use the new codes. Most often the physician would perform this under radiological guidance, which is included in the new CPT codes, Ferragamo says.

Upgrade Your Cryo Ablation to Category I

Say goodbye to temporary code 0135T (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy). January’s changes delete this code and replace it with 50593, which has the same descriptor.

"I am glad they are getting a code for this," Shanley says. Her office usually collects an advance beneficiary notice (ABN) form from patients before performing a cryotherapy renal tumor ablation.

"Only a small portion of our contracted payers pay for 0135T, and Medicare never pays it," says Maryann Ward, a coder with the department of urology of Johns Hopkins University in Baltimore. Some patients can’t undergo an open renal tumor ablation because of comorbidities, she says. She hopes Medicare will cover the procedure now that it has a Category I code.

"I think the new CPT code will be the first step in paving the way for more payers to recognize this as a billable service," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.

Look Forward to Bladder Aspiration Clarification

Three of the new codes you need to add to your urology code set are for aspiration of bladder and suprapubic (SP) tube insertion. CPT 2008 renumbers 51000-51010, but the descriptors will remain the same, specifying the way in which your urologist performs the aspiration:

• 51100 -- Aspiration of bladder; by needle

• 51101 -- ... by trocar or intracatheter

• 51102 -- ... with insertion of suprapubic catheter.

"That area of coding has been deficient in the past," Hause says. "We’ve always struggled with how to code for an insertion of a suprapubic catheter and whether that includes the aspiration, and what was the difference between a trocar and a needle. It’s clear now that the first two codes --51100 and 51101 -- are for aspiration, and 51102 is intended for the SP tube."

Differentiate 51102 and 51040: Coders may struggle with determining when to report 51102 and 51040 (Cystostomy, cystostomy with drainage), Hause says. "If the urologist does an open SP tube insertion, you’ll still want to use 51040."

Add 52649 for HoLEP

You’ll also have a new code for laser enucleation of the prostate, or HoLEP procedures (52649, Laser enucleation of the prostate with morcellation, 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]).

"This will be the new code for the HoLEP procedure. This is different than the HoLAP procedure, which is coded with 52648," says Shirley Thacker, surgical coder for Methodist Urology in Indianapolis. "The new code 52649 does not replace an old code but rather is an addition to the codes that are now in use."

Previously, you had to use code 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]) to report HoLEP procedures, Thacker says. "This was the closest code but was not an accurate reflection of the work being done."

Remember: CPT states that you can’t report 52649 with 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]) and 52648, Ferragamo says.

"This is a great change for urology coders in that it accurately reflects the procedure that is performed, along with the work value associated with it," Thacker says.

Be Cautiously Optimistic on 51797 Changes

CPT 2008 also gives voiding pressure studies code 51797 add-on status, revising the descriptor to clarify that you should list it separately in addition to a primary procedure. The new descriptor reads: Voiding pressure (VP) studies; intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal) (list separately in addition to code for primary procedure).

More good news: "That’s actually good news for urology practices because unless they significantly reduce the reimbursement on that code, the code descriptor will result in increased reimbursement for urologists because it won’t be subject to multiple-procedure reductions," Hause says.

Keep in mind: According to CPT, you should use 51797 only with 51795 (Voiding pressure [VP] studies; bladder voiding pressure, any technique), Ferragamo says.

Wait and see: Practices will have to wait until CMS releases the 2008 Medicare Physician Fee Schedule to see how carriers will reimburse you for 51797. CMS may reimburse you at 100 percent for 51797 since it’s an add-on code, but could also reduce the overall payment on the code to compensate, Hause says.