Urology Coding Alert

Several new codes offer more specifics about the type of tumor your urologist removed.

CPT Codes 2010 offers several new tumor removal codes your urologist might use if he treats back, flank, or abdominal wall tumors -- but you'll need solid documentation from your urologist to choose the right code. Dig into the details of the new codes with this expert rundown.

Check the Documentation for Important New Details

The codes are characterized according to size, location, depth, and malignancy, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. You'll choose the excision code based on the following criteria:

1. Is the excision a radical excision -- in other words, is the tumor malignant?

2. Is the tumor located subcutaneously, subfascial, intramuscular, or deeper?

3. What is the size of the tumor removed?

Existing codes 21930 (Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm), 21935 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of back or flank; less than 5 cm), and 22900 (Excision, tumor, soft tissue of abdominal wall, subfascial [e.g., intramuscular]; less than 5 cm) have the additional wording to indicate tumor size. The AMA added several other codes to cover additional sizes. See the chart on page 107 for the actual codes along with their descriptors.

Documentation essentials: "Knowing the size, depth, [and location] of these tumors will be key in making these new and revised codes work and should enhance the success of appeals with denials in the case of multiple tumors in different areas," says Kristine Newton, CPC, a billing coordinator in Sarasota, Fla. You must have a conscientious surgeon who will be sure to dictate these findings in his operative report so the coder can successfully select and use the new codes, she adds.

Call your urologist's attention to the greater burden of documentation the new musculoskeletal tumor excision codes require, recommended Albert E. Bothe, Jr, MD, FACS, with the American College of Surgeons in "Excision of Soft Tumors/Bone Tumors" at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago. "If the surgeon documents just the size of the lesion and not the resection size, you could end up with a lower code."

Don't miss: "The best time for the surgeon to indicate the resection's size is when he's doing the removal," said John P. Heiner, MD, a professor at University of Wisconsin Hospital and Clinics and a physician at Williams S. Middleton Memorial Veterans hospital in Madison, Wis. during the Symposium in Chicago. Once the specimen is put in the jar and sent to pathology, the specimen shrinks down significantly, sometimes to half its original size. Therefore, if you're coding from the size listed on the pathology report, you could be undercoding by almost half the size, which will cost you up to $20 or more per excision.

Home in on When You'll Use Each Code

Check out these instances when your urologist might call on these new codes:

Example 1: A urologist may use the back and flank tumor excision codes when he removes a malignant flank tumor resulting from "wound seeding" during a previous radical nephrectomy for a kidney cancer.

Example 2: He may use an abdominal wall tumor excision code for "an abdominal wall tumor that is benign, such as a lipoma, or a malignant metastasis from a genitourinary tumor," Ferragamo says. "Urologists may be involved in these types of surgeries because of previous involvement with the original tumor."

Stop relying on 22: "Until these codes, there has never been a way to express the depth of a tumor or tumorous mass except with modifier 22 (Increased procedural services)," says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net. "In theory, the size of a tumor should fairly well reflect the depth and difficulty in terms of work that has to be done to remove the tumors. Payment received should be reflective of that work -- more money for more work."