Urology Coding Alert

Plus, you’ll have three new urology-related add-on codes in 2016.

The 2016 changes in the renal repair section of the CPT^® manual are not the only ones you’ll need to focus on if you want to keep your urology practice on track for the new year. Here’s the scoop on some additional changes you will want to review to ensure that you won’t face denials and lost reimbursement come January 1. 

Add 54437, 54438 To Your Code List

If your urologist performs a penile repair for a patient with a traumatic injury, you’ll have two new codes to check out. For penile trauma repair performed in a facility, such as an ambulatory surgical center (ASC) or hospital, review the following new codes:

• 54437 — Repair of traumatic, corporal tear(s). According to the proposed 2016 Medicare Physician Fee Schedule (MPFS), this code will carry 19.40 total RVUs so you can expect just over $700 for this procedure.
• 54438 —Reimplantation, penis, complete amputation including urethral repair. Per the 2016 MPFS, CMS will assign 35.37 total RVUs for this code, bringing you nearly $1280 for this procedure.

Note: In the past, you would have reported penile trauma injury repairs using 54440 (Plastic operation of penis for injury), Ferragamo says. “CPT^® code 54440 was nonspecific and used in many various different clinical scenarios for both traumatic and congenital malformations of the penis because no other codes were available,” he adds.

These codes reflect additional specificity, says Jonathan Rubenstein, MD, director of coding and physician compliance for Chesapeake Urology Associates in Baltimore.

“For example, a repair of a complete penile amputation, with 35.37 RVUs, shows the increased work compared to the less specific code 54440,” he adds. “In general, the more accurate the code for a procedure, the more likely the provider will be reimbursed for the work that they do, without questioning whether the work they did is greater than the listed procedure or less than the listed procedure.”

Don’t Forget Add-On Codes

CPT^® 2016 will also offer you the following three new add-on codes starting January 1:

• 50606 — Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
• 50705 — Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
• 50706 — Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure).

“Until we have more detailed information from CPT^® as to which primary CPT^® codes the above add on codes may also be billed with, use them with the diversionary CPT^® codes 44380 (Ileostomy, through stoma, diagnostic…) and 44385 (Endoscopic evaluation of small intestinal pouch [eg, Kock pouch, ileal reservoir [S or J], diagnostic…) when examining an ileal conduit or an abdominal urinary pouch,” Ferragamo advises.