Urology Coding Alert

If you’re a facility coder, add these codes to your arsenal.

If your urologist performs surgical procedures in the outpatient setting and you code for the facility side, you’ll want to take note of some new codes coming your way in the HCPCS Level II 2023 code update. Unfortunately, new codes don’t always mean new reimbursement. Here’s what you need to know.

Turn to New Code for Single-Use Endoscope

The HCPCS Level II 2023 update adds new code C1747 (Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)). “There are several companies that are manufacturing the single-use endoscope for the urinary tract as well as single-use endoscopes used in otolaryngology, anesthesia, gastroenterology, gynecology, orthopedics, and pulmonary procedures,” says Stephanie Stinchcomb Storck, CPC, CPMA, CCS-P, ACS-UR, longtime urology coder and consultant in Glen Burnie, Maryland.

To determine if this is the right code for the procedure your urologist performed, you’ll want to turn to the official definition on single use. According to Storck, the Food and Drug Administration (FDA) classifies a reusable medical device and single-use medical device as follows:

Reusable: “Reusable medical devices are devices that healthcare providers can reprocess and reuse on multiple patients.”

Single-use: “A single-use device, also referred to as a disposable device, is intended for use on one patient during a single procedure. It is not intended to be reprocessed (cleaned, disinfected/sterilized) and used on another patient.”

Payment caution: You’ll find that C1747 has a status indicator of NI (New code for the next calendar year or existing code with substantial revision to its code descriptor in next calendar year as compared to current calendar year, interim APC assignment; comments will be accepted on the interim APC assignment for the new year) in the Outpatient Prospective Payment System (OPPS). This means the facility will not receive payment for services billed using this code, Storck warns. Physician payment will not be affected.

Update Coding for Renal Pelvis Catheter Internally Dwelling Procedures

The 2023 update to HCPCS Level II codes includes the following four new codes related to renal pelvis catheter procedures:

• C7546 (Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation)
• C7547 (Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dialation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)
• C7548 (Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)
• C7549 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation)

According to Storck, these codes are similar to the following CPT^® codes:

• C7546 is like 50387 (Removal and replacement of externally accessible nephro­ureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation).
• C7547 is like 50434 (Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract).
• C7548 is like 50435 (Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation).
• C7549 is like 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit).

The difference is that the code descriptors for C7546-C7549 specifically include the ureteral stricture balloon dilation performed in the outpatient and ambulatory surgical center setting. “This means that these codes should be used in the outpatient setting if ureteral dilation is performed in the removal/replacement, conversion from nephrostomy catheter to nephroureteral catheter, exchange of nephrostomy catheter, or change of ureterostomy tube or stent via ileal conduit,” Storck advises.

Watch out: All of these new C codes have a status indicator of EI (Items, codes, and services not covered by any Medicare outpatient benefit category; statutorily excluded; not reasonable and necessary) in the OPPS. Storck warns that this means payers will not reimburse facilities for these codes when the facility submits them on outpatient claims. Your urologist’s reimbursement will not be affected.

Switch From C9738 to C7550/4 for Cysview^®

You’ll have new codes to report in place of C9738 (Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)) in 2023:

• C7550 (Cystourethroscopy, with biopsy(ies) with adjuctive blue light cystoscopy with fluorescent imaging agent)
• C7554 (Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent)

You’ll report these new codes in the outpatient and ambulatory surgical center setting “to describe the cystoscopy procedure with the blue light detection and a cystoscopy with biopsy procedure with the blue light detection,” Storck explains. The procedures use Cysview®, an optical imaging agent, she adds. “The agent, hexaminolevulinate hydrochloride, is indicated in the cystoscopic detection of carcinoma of the bladder. When used under a special blue light during a cystoscopy procedure, the bladder cancer will light up so the urologist can see the cancer.”

In the past, you would have reported this service using C9738. For the agent itself, report A9589 (Instillation, hexaminolevulinate hydrochloride, 100 mg).

Payment status: This code has a status indicator of N (Items and services packaged into APC rates). “Therefore, there is no separate APC payment,” Storck says.