Urology Coding Alert

Heads up: You'll have new abdominal/pelvic CPT Codes to use in the new year.

Have you been searching for a code to reflect the evaluation and management service your urologist performs during a subsequent visit with a patient in observation care? If so, CPT 2011 brings welcome relief in the form of 99224-99226. These codes are among a handful of new codes that could solve tricky claims you may be facing now. Be the first coder to glean what else is potentially new for your urology practice, so that you can be proficient when Jan. 1 hits.

Brace For New Observation Codes

One of the biggest changes for next year is that CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/ or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit

99225 -- Subsequent observation care, per day, for theevaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit

99226 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

Before 2011, coding for the "middle days" of an observation service was a problem, says Jill Young, CPC, CEDC, CIMC, principle with Young Medical Consulting LLC in East Lansing,Mich.

 "Although not the norm, there are situations where a patient is admitted to observation and remains in that status for three or more days," Young explains.

When to use: "If you had a patient admitted to observation on July 1 and discharged from observation on July 3, the problem for coders was how to bill for July 2," Young says. In 2011, you'll use 99224-99226 for July 2.

Downside: You won't be jumping for joy when they hear the accepted payments for these codes. The Relative Value Update Committee had compared new codes 99224-99226 for subsequent observation care to subsequent hospital care and had requested the same work value. The Center for Medicare, however, disagreed with the proposal. "Instead, to recognize the differences in patient acuity between the two settings, we have removed the pre- and post-services times from the values, reducing the values to 75 percent of the value for subsequent hospital care codes," announced Kenneth Simon, Senior Medical Officer for Center for Medicare at the CPT and RBRVS 2011 Annual Symposium on Nov. 10 in Chicago.

Sort Through Radiation Implant Changes

Among the list of brand new codes are radiation implant codes that you may use occasionally in your urology practice. They are:

49327 -- Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure). This is an add-on code and you should only bill it with laparoscopic abdominal, pelvic, or retroperitoneal procedure[s] performed concurrently.

49412 -- Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure). This is an add-on code and you should only bill it with an open abdominal, pelvic, or retroperitoneal procedure[s] performed concurrently.

49418 -- Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous.

Don't Miss In-Office Radiological Procedure Changes

If your urology office performs in-office CT scans of the abdomen and pelvis at the same encounter will now be able to bill these two services with a single radiology code as opposed to having to code two radiology codes as you have prior to Jan. 1, 2011. The following three codes should come in handy Jan. 1:

74176 -- Computed tomography, abdomen and pelvis; without contrast material

74177 -- ... with contrast material(s)

74178 -- ... without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

How it works: Current reports indicate that CPT will not be deleting the current abdominal CT 74150, 74160, and 74170 codes, or pelvic CT, 72192, 72193, and 72194 codes, so you'll have 74176-74178 in addition to the abdominalonly and pelvic-only codes. Do not report 74176-74178 in conjunction with pelvic codes 72192-72194 or in conjunction with abdominal codes 74150-74170. The composite codes (74176, 74177, and 74178) take the place of the two separate codes, which you billed for the abdominal and pelvic CT scans performed at the same encounter in 2010. Remember to report 74176, 74177, and 74178 only once per CT of abdomen and pelvic examination.

Bad news: Unfortunately relative value units (RVUs) for these new combined radiology codes and procedures will be less than the RVUs for the two separate radiological procedures that were billed last year.