Urology Coding Alert

CPT® 2021:

Get All the Pertinent 2021 CPT® Updates With This Guide

Cover all your bases with this review of new, revised, and deleted codes.

In a year preceding one of the biggest shakeups to the evaluation and management (E/M) landscape in decades, you’ll be comforted to know the corresponding urology CPT® changes aren’t half as daunting. In fact, you can count on two hands the complete number of changes of new, revised, and deleted urology codes to consider for Jan. 2021 implementation.

While the list is short, you’ll find the covered services spans everything from ablations to cystourethroscopies to antegrade urography procedures.

Read on for a complete breakdown of all the essential new, revised, and deleted CPT® 2021 coding considerations for urology.

Add a New Transrectal Prostate Ablation Code to Your Arsenal

While all the changes deserve equal consideration, you want to pay specific attention to those respective new codes that will most frequently find their way into your operative report coding. Begin with this long-awaited code that you’ll report for surgical encounters involving transrectal ablation of malignant prostate tissue:

  • 55880 (Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance)

This procedure involves the surgeon introducing an HIFU transducer into the anus and rectum in order to ablate, or destroy, malignant prostate tissue. However, you need to understand how this procedure fits alongside a few existing CPT® Category I and Category III codes you may also consider for services involving the ablation of malignant prostate tissue:

  • 55873 (Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring))
  • 0421T (Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/ or dilation, and internal urethrotomy are included when performed))
  • 0582T (Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance)

Besides the fact that the methods for ablation vary considerably from 55880, you will notice that none of these procedures involve a transrectal ablation. Code 55873, while absent in the code description, involves the introduction of thin needles into the perineal region. “CPT® code 55880 will typically be performed on patients with localized prostate cancer that are not candidates for radical treatment,” says Melanie B. Scott, CPC, CPPM, CMPE, director of operations at Five Valleys Urology in Missoula, Montana.

Many billers and practice managers will attest that lack of an existing code for this procedure has proved to cause headaches for urology practices. “Previously, you’d report this service with 55899 (Unlisted procedure, male genital system), per American Urological Association (AUA) guidelines,” relays Janet Kidneigh, COC, CPC, senior urology surgery coder at The Coding Network, LLC. “However, Medicare was typically quick to deny these claims. The creation of code 55800 will drastically improve the chances of reimbursement going forward,” Kidneigh explains.

Note: You will find an existing HCPCS Level II code for transrectal ablation of malignant prostate tissue: C9747 (Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance). However, this code is designated for Outpatient Prospective Payment System (OPPS) reporting, only, as are all HCPCS Level II C codes.

Consider This Series of New Category I and III Codes

Next up is a new Category I code for computer-aided mapping during colposcopy procedures:

  • 57645 (Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (List separately in addition to code for primary procedure))

Since the introduction of the Dynamic Spectral Imaging System (DYSIS), it’s been utilized most often by gynecologists and urogynecologists as a means of digitally mapping and measuring cervical pre-cancers. Prior to 2021, coders had to resort to appending modifier 22 (Increased procedural services) for colposcopy procedures that included this form of computer-aided mapping, with limited success in achieving the desired reimbursement.

While your breakdown of new Category I CPT® codes ends here, there are three more new and important Category III codes to add to your 2020 and 2021 coding database:

  • 0596T (Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement)
  • 0597T (…replacement)
  • 0619T (Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed)

Refresher: Category III codes are designated for procedures classified as “emerging technology.” Once the Category III designation is made, the codes are given a five-year window to either be converted to a Category I code or deleted from the CPT® code book. While these codes are considered “new” within the 2021 CPT® code book, keep in mind that they’ve actually been in effect since July of 2020 as per the quarterly update to the Medicare Physician Fee Schedule Database (MPFSDB).

Don’t Neglect the Importance of Revised and Deleted Codes

To round out your knowledge, have a look at the following set of revised and deleted urology codes:

  • Revised (emphasis added): 74425 (Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation)
  • Deleted: 58293 (Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control)
  • Deleted: 57112 (Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy)

Amongst other considerations, the decreased frequency of reporting of codes 58293 and 57112 played a role in the decision to delete them from the CPT® code set. As for 74425, you’ll see the only difference in code revision is the removal of “pyelostogram, nephrostogram, loopogram.” While these key terms are removed from the code description, you shouldn’t necessarily conclude that these services will no longer be considered one-in-the-same with an antegrade urography.

In some instances, such as in the coding of a nephrostogram, you should opt to report an entirely separate code. Nephrostogram imaging guidance and injection services should be reported using code ranges 50430-50431, 50434-50435, and 50693-50695. Similarly, the 2020 CPT® index will direct you to code 74420 (Urography, retrograde, with or without KUB) for a pyelogram. However, you’ll find that the 2020 CPT® index routes you back to code 74425 when you search for “Loopogram.”

Disclaimer: Keep an eye out for routing changes within the CPT® index. There are no guarantees that these respective searches will yield the same results in the index of the 2021 CPT® code book.