Urology Coding Alert

Get a glimpse of the codes you'll be using in January so you can prepare now.

January is just around the corner, so there's no time like the present to start easing your practice into the CPT Codes 2011 changes that will be in effect on the first day of the year. The good news is that you don't have much you'll need to change starting Jan. 1. A Category I stress incontinence (SUI) treatment code and a revised laparoscopic prostatectomy code descriptor are just two of the relatively few CPT 2011 changes your urology practice will want to get to know. Plus, watch out for 11042-11047 descriptor revisions.

Scrap Category III for Payment-Friendly SUI Treatment Code

CPT 2011 deletes 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence). Instead of 0193T, you'll find new code 53860 (Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) in its place.

Remember: Category III codes are temporary codes for emerging technology, services, and procedures that allow the Centers for Medicare and Medicaid Services (CMS) to collect data on the use of these new services -- an ability unlisted codes do not possess. If a Category III code for a service exists, you should report the Category III code and not an unlisted Category I (CPT) code.

The problem with Category III codes is that category III codes offer no promise for reimbursement. Now, when your urologist performs a transurethral radiofrequency microremodeling of the female bladder neck, you'll have a permanent code -- 53860 -- that payers should reimburse. "This procedure can be performed in an office or hospital setting," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. "The CPT code 53860 has a 90- day global and in office total relative value units (RVUs) of 43.17. Using the proposed 2011 conversion factor of $25.5217, one would be paid $1,101.77 when performing this procedure in an office setting."

Stop Separately Reporting US Guidance With Some Lap Procedures

January doesn't bring only new codes; you'll want to pay attention to code descriptor revisions as well.

First, watch out for a new descriptor on code 50542, which now reads: Laparoscopy, surgical; ablation of renal mass lesion(s), including intra-operative ultrasound guidance and monitoring, when performed. Adding "including intra-operative ultrasound guidance and monitoring, when performed" to 50542 invalidates the additional billing of 76940 (Ultrasound guidance for and monitoring of, parenchymal tissue ablation). You'll no longer be able to separately report ultrasonic guidance by adding 76940 to your laparoscopic renal mass ablation claims.

You should also pay attention to the new descriptor for 55866: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed. Adding "includes robotic assistance, when performed" to 55866 mean you will no longer be able to additionally report codes S2900 (Surgical techniques requiring use of robotic surgical system [list separately in addition to code for primary procedure]) and 51999 (Unlisted laparoscopic code, bladder) for robotic reconstruction of the bladder neck. Beginning Jan. 1, you should not be billing those latter codes as additional procedures, which in the past you billed to indicate the use of the robot, Ferragamo warns.

Additionally: For urology, be on the lookout for the following revised descriptors as well:

50250 -- Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intra-operative ultrasound guidance and monitoring, if performed

55876 -- Placement of interstitial device(s) for radiation therapy guidance (e.g.,

fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple.

Category II: Category II codes help better describe E/Ms and can correlate a patient's condition to the treatment rendered, says Denae M. Merrill, CPC, coder for Covenant MSO in Saginaw, Mich. You've got two new F codes to use:

3008F -- Body Mass Index (BMI), documented (PV)

4004F -- Patient screened for tobacco use AND received tobacco cessation counseling, if identified as a tobacco user (PV).

Category II codes are the denominator in PQRI reporting, so it's in your best interest to use them.

Differentiate Debridement Codes By Depth

You'll also find that CPT has revised debridement codes to include the size of the area debrided, and will introduce three new codes to describe additional areas that the physician debrides. The changes are as follows:

11042 (Revised) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less

11043 (Revised) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less

11044 (Revised) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less

11045 (New) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

11046 (New) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

11047 (New) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure).

Note: Codes 11045-11047 are add-on codes, meaning you cannot report those codes independently. Instead, you bill those codes as a second code with another primary procedure code. You would report 11045 with 11042, 11046 with 11043, and 11047 with 11047. The good news is that "in general urological practice these procedures (and their proper coding) are infrequently performed by urologists," according to Ferragamo.

"Depth is the only documentation item you need to determine the correct code," explained Chad Rubin, MD, FACS, American College of Surgeons AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation "General Surgery" at the CPT and RBRVS 2011 Annual Symposium on Nov. 10 in Chicago.