Urology Coding Alert

Plus: Add several new Category II codes to your PQRI arsenal.

You'll have more than just new transurethral resection of the prostate (TURP) codes to learn by January. CPT Codes 2009 also changes the way you report prostatic needle biopsies, and gives you new codes to use if you participate in the Physician Quality Reporting Initiative (PQRI) program. Take a look at changes you need to know.

Avoid 55706 and 55700 Combinations

 Starting next year, you'll have another code for prostatic needle biopsies. Take note of new code 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance), which replaces Category III code 0137T.

 "This procedure is for obtaining an exceptionally large number of additional biopsies of the prostate gland in an individual whose previous biopsies have been negative, but there remains a strong clinical suspicion for prostatic carcinoma," explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, N.Y.

 Caution: Pay attention to the note following this new code, which says you should not report 55706 with 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). "This makes sense as saturation biopsies are inclusive of single and multiple biopsies," says Jonathan Rubenstein, MD, with Chesapeake Urology Associates in Baltimore.

 Also note that imaging guidance is included, Ferragamo points out. "Do not also code for the guidance with CPT code 76942 (Ultrasonic guidance for needle placement [e.g.,. biopsy, ... ] imaging supervision and interpretation)."

Incorporate 7 New Codes for PQRI

 You'll have several new Category II CPT codes you can use if you participate in the PQRI program.

 Under PQRI, you report special Category II codes on your claims. Here are the new codes to add on Jan. 1:

• 3268F -- Prostate-specific antigen (PSA), AND primary tumor (T) stage, AND Gleason score documented prior to initiation of treatment (PRCA)
• 3271F -- Low risk of recurrence, prostate cancer (PRCA)
• 3272F -- Intermediate risk of recurrence, prostate cancer (PRCA)
• 3273F -- High risk of recurrence, prostate cancer (PRCA)
• 3274F -- Prostate cancer risk of recurrence not determined or neither low, intermediate nor high (PRCA)
• 4200F -- External beam radiotherapy to prostate only (PRCA)
• 4201F -- External beam radiotherapy for prostate cancer to region(s) other than prostate only (PRCA).

Pointer: Check and consult Appendix H of the CPT manual for additional and further descriptions of Category II codes pertaining to treatment of carcinoma of the prostate and suitable for PQRI documentation, Ferragamo suggests.