Urology Coding Alert

Watch for tobacco use correlations to urologic cancers.

While there are not major HCPCS Level II changes that will alter your 2023 coding, there are some new codes you should review and some deleted codes that you should pull out of rotation. Take a look at this expert overview to save time and energy scouring the updates.

Look to New Codes for Kidney Health Evals

If your urologist works with a nephrologist or your practice is a dual-specialty practice, you should add four new M codes to your HCPCS Level II list. In 2023 you’ll be able to report the following codes:

• M1187 (Patients with a diagnosis of end stage renal disease (ESRD))
• M1188 (Patients with a diagnosis of chronic kidney disease (CKD) stage 5)
• M1189 (Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (EGFR) and urine albumin-creatinine ratio (UACR) performed)
• M1190 (Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (EGFR) and urine albumin-creatinine ratio (UACR))

“There is a new MIPS Value Pathway [MVP] for optimal care for kidney health to be used by nephrologists in 2023,” explains Stephanie Stinchcomb Storck, CPC, CPMA, CCS-P, ACS-UR, longtime urology coder and consultant in Glen Burnie, Maryland. “Also, there is a new kidney health evaluation quality measure: 488. The numerator for the measure is the descriptor for M1189. The descriptions for M1187 and M1188 are denominator exclusions. M1198 describes if no EGFR and UACR were performed. However, the codes are not included in the table for quality measure 488.”

Stop Using G9631-G9633 in 2023

You won’t find these three codes in HCPCS Level II 2023:

• G9631 (Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery)
• G9632 (Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury))
• G9633 (Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery)

“These codes could have possibly been used by urologists,” says Storck. “There are some instances where urologists have to go in during a procedure and repair ureters injured by another physician.” Storck suggests that these codes were deleted since related quality measure 434 (Proportion of patients sustaining a ureter injury at the time of pelvic organ prolapse repair) was deleted in 2022.

Notice Revised Tobacco Screening Codes

When a patient has bladder cancer, your urologist may attribute the disease to the patient’s tobacco use. Therefore, you’ll want to pay attention to one G code deletion and two revisions.

HCPCS Level II 2023 changes include the deletion of G0028 (Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)). You’ll also see revisions to the following codes (emphasis added to show revisions):

• G0029 (Tobacco screening not performed or tobacco cessation intervention not provided on the date of the encounter or within the previous 12 months, reason not otherwise specified during the measurement period or in the six months prior to the measurement period)
• G0030 (Patient screened for tobacco use and received tobacco cessation intervention on the date of the encounter or within the previous 12 months during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user)

You’ll also find G9904 (Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)), G9907 (Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)), and G9909 (Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)) deleted.

HCPCS 2023 also revises three more code descriptors as follows:

• G9905 changes from Patient not screened for tobacco use, reason not given to Patient not screened for tobacco use.
• G9906 changes from Patient identified as a tobacco user received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy) to Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmaco­therapy).
• G9908 changes from Patient identified as tobacco user did not receive tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy), reason not given to Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy).

Keep reading: See the article “Solidify Your 2023 Prolonged Service Coding With 4 Steps” below for a rundown of the CMS 2023 prolonged services HCPCS Level II code changes.

Stay tuned: Watch for an article in the next issue of Urology Coding Alert on additional HCPCS Level II code changes that you’ll use for outpatient facility coding in 2023.