Urology Coding Alert

Don’t miss Kock pouch and ileal conduit updates in the surgery section.

Although fall has just begun, the new year will be here all too soon, so now is the time to prepare yourself for the upcoming CPT® code changes. The good news is there aren’t sweeping changes that will alter your urology coding, but if you miss a few key changes, you’ll face denials starting Jan. 1, 2015. 

Let us give you the rundown of which changes might affect your practice so you don’t have to waste precious time scouring all the new, deleted, and revised codes. Here’s what you need to know in urology. 

Adopt 2 New Urology Codes

There will be two new 2015 CPT® endoscopic codes for urology as follows:

• 52441 — Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
  
• +52442 — ... each additional permanent adjustable transprostatic implant (list separately to code for primary procedure).
  

“Unfortunately we will have to wait for further explanations from CPT® and CMS as to when these new codes are to be used,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of  urology at the State University of New York at Stony Brook.

Revise Your Kock Pouch Inclusions

There are also changes in how you will report endoscopic evaluation of an abdominal or pelvic pouch, such as a Kock pouch or ileal reservoir. CPT® 2015 alters the descriptor for 44385 and 44386 as follows (emphasis added)

• 44385 — Endoscopic evaluation of small intestinal pouch (abdominal eg, Kock pouch, ileal reservoir [S or pelvicJ]) pouch; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure)
  
• 44386 — ... with biopsy, single or multiple. 
  

“These codes now clarify that the endoscopy is an examination of a particular urinary diversion, a ‘Kock’ pouch or an ‘ileal reservoir,’” Ferragamo explains.   

Look at the Surgery Updates, Too

There are other changes in the surgery/digestive section of the CPT® manual, which may also be of interest to urologists performing urinary intestinal diversions, Ferragamo points out. 

 As of Jan. 1, you will find the descriptor for 44380 updated to read (emphasis added — strikeout is deleted text and underline is added text): Ileoscopy, through stoma; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure). You’ll use this code for endoscopy of an ileal conduit, Ferragamo explains. 

A new code for 2015 — 44381 (Ileoscopy, through stoma; with transendoscopic balloon dilation) — will be for endoscopy of an ileal conduit and dilation of a stomal stenosis, adds Ferragamo. “This CPT® procedure code has been needed to describe a service often performed by urologists treating the common problem of stenosis of the cutaneous opening of an ileal conduit.”  

CPT® 2015 deletes ileoscopy code 44383 (Ileoscopy, through stoma; with transendoscopic stent placement [includes predilation]). In its place, you will find a new 2015 code: 44384 (Ileoscopy, through stoma; with placement of endoscopic stent [includes pre- and post-dilation and guide wire passage, when performed]). 

“This code may be used for endoscopic placement or change of ureteral stents or catheters directly through and via an ileal conduit,” Ferragamo says. You will use 44384 for either unilateral or bilateral procedures.

You will also have new endoscopic coding for evaluation of a sigmoid conduit:

• 44401 — Evaluation of a sigmoid conduit with ablation of tumor(s), polyps, or other lesions
  
• 44402 — ... with endoscopic stent placement
  
• 44403 — ... with endoscopic mucosal resection
  
• 44404 — ...direct submucosal  injection, any substance (for example, Botox)
  
• 44405 — ... with transendoscopic balloon dilation (for an endoscopic dilation of a sigmoid conduit stomal stenosis).
  

Additionally: The descriptor for the unlisted CPT® code 44799 will include the word “small” as of January so it will read Unlisted procedure, small intestine. “This unlisted code may be used for dilation of an ileal conduit stomal stenosis,” Ferragamo explains.