Urology Coding Alert

A new code means you may actually get paid -- unless CCI Edits steps in.

The new year should ring in change in a user-friendly system thanks to a new payment-catching code for the Spanner procedure.

Make sure you incorporate the urethral stent insertion and urogynecology changes come January. Here's what you need to know.

Scrap Category III Code For Payment-Friendly Code

When your urologist inserts a temporary urethral stent, you now have a permanent code that payers should reimburse. New code 53855 (Insertion of a temporary prostatic urethral stent, including urethral measurement) replaces the Category III code 0084T with the same descriptor. Category III code 0084T offered no guarantee of reimbursement.

Use 53855 for the Spanner procedure. "53855 is a code for a relatively new procedure/device," says Paul Arnold, MD, of Bay Urology in Safety Harbor, Fla. Payers did not always recognize the Category III code.

"Now, there is a code which will allow the procedure to be reimbursed easier," Arnold adds.

Category III codes are important tracking mechanisms that have the ability to become regular CPT codes, as in the case of 0084T becoming 53855. They exist to report certain emerging technology, services, and procedures that aren't yet listed under Category I and would normally be reported with unlisted procedure codes.

Problem: You should report a Category III code that accurately describes the service when there is no other option under the Category I codes, even if reimbursement is doubtful. So having a Category I code to report temporary urethral stent insertions means money for your practice.

Watch out: The Correct Coding Initiative (CCI) will no doubt bundle 53855 with several urological procedures, cautions Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. Watch for a CCI update article in Urology Coding Alert when the new edits come out in January

Add Vaginal Graft Revision/Removal Code for Urogynecology

If your urologist performs urogynecological procedures, you'll want to add 57426 (Revision [including removal] of prosthetic vaginal graft, laparoscopic approach) to your coding arsenal.

This change completes the code set for a vaginal graft revision, says Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M. In 2006, the AMA added the code for the vaginal approach (57295, Revision [including removal] of prosthetic vaginal graft; vaginal approach). Then in 2007, they added the code for the abdominal approach (57296, Revision [including removal] of prosthetic vaginal graft; open abdominal approach). "And now we have a code for the laparoscopic approach," Witt says. "All three accomplish the same procedure, but just via a different surgical approach."

You may not use this new code very often, however. "Usually when a vaginal graft is removed or revised, a vaginal approach is used and not a laparoscopic approach," Arnold says.

For more in-depth discussion about how these CPT 2010 changes will affect your urology coding, sign up for the December 17th audioconference "2010 Urology Coding Update" being presented by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. Go to