Urology Coding Alert

Read this preview to make sure your office is up-to-date on new laparoscopy and urethrolysis codes

Significant changes for urology practices are on the way, including a new urethrolysis procedure (53500) as well as a laparoscopy code (57425) for the new CPT in 2004.
 
CPT Codes 2004 includes a new code for transvaginal urethrolysis procedures: CPT 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]). If a urologist performs this procedure retropubically - from above - report 53899 (Unlisted procedure, urinary system).
 
The new manual also includes a code for a laparoscopic colpopexy, 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]), a procedure in which a surgeon suspends the vaginal apex to correct vaginal prolapse.
 
This new procedure will become more common for urologist and coder alike because it's an improvement on the old transabdominal approach, 57280. Laparoscopic procedures are less invasive and have fewer postoperative problems such as postoperative pain, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, N.Y.
 
"Also, much less time is needed to heal a large abdominal incision and for a much more rapid return to normal life and work," Ferragamo says.
 
"Initially the insurance carriers perceived these procedures as less technical, less demanding, and simpler for the surgeon to perform," Ferragamo says. "However, contrary to their opinion, the laparoscopic procedures require a much steeper learning curve and much more skill to perform. Realizing this, the carriers are now reimbursing more for the laparoscopic procedures than for the comparable open operations."
 
A urologist may do this procedure as part of a repair of the pelvic floor. This procedure may be done by either a urologist or a gynecologist, Ferragamo says.
 
"Sometimes urologists who do a lot of pelvic-floor reconstruction may want to use that code, but probably that would be used by a gynecologist or a urogynecologist," Ferragamo says. "There are many urologists now doing pelvic-floor reconstruction."
 
One specialist procedure of interest to urologists is a new guidance method for doing in utero fetal surgery, 59897 (Unlisted fetal invasive procedure, including ultrasound guidance). The code may be new, but the procedure isn't. "Certainly that procedure has been done for more than 20 years," says Michael Harrison, MD, chief of pediatric surgery, director of the Fetal Treatment Center and professor of surgery and pediatrics at the University of California San Francisco.
 
"We did the first one in 1981," Harrison says. "It has evolved, so it's quite different than it was at the beginning, but it's always been done with ultrasound guidance."

Stars Fall in 2004

The new manual also eliminates starred procedures. A star (*) beside a CPT code denotes a relatively minor surgical procedure that may require variable amounts of preoperative and postoperative services. The AMA marked procedures with a star to indicate that only the procedure is included in the payment. But CPT's definition of a "minor procedure" does not correlate with the global periods instituted by insurance carriers.
 
"[Starred procedures] have been irrelevant," says Margaret Lamb, RHIT, CPC, of the Great Falls Clinic in Great Falls, Mont. "They don't seem to mean anything to anybody anymore, so I think that was a good change.
 
"The rationale behind it [starred procedures] was that it really was a billing issue, and the CPT isn't supposed to be billing rules," Lamb says. "I don't think the CPT book should be putting forth billing rules. What they are supposed to do is to just give codes."
 
"Use the 0-, 10- and 90-day global concept as championed by Medicare and other carriers," Ferragamo says. Don't use the CPT guide to determine whether you can separately report pre- and postoperative services.
 
The new code 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation) replaces 76490 (be sure not to transpose the numbers). Report this radiological study with the laparoscopic or percutaneous ablation of renal mass lesion(s) (50542, Laparoscopy, surgical; ablation of renal mass lesion[s]) with the appropriate documentation.
 
Although these CPT changes will take effect on Jan. 1, 2004, consult your carriers for their specific timetable for implementing these changes. Carriers have a grace period to update their software. Some will require immediate use of the new codes, while others may not reimburse your practice immediately when you use the new codes.

Don't Forget to Use V-Code Changes in ICD-9

Carriers and coders have had a grace period of up to three months to update their software to reflect the ICD-9 changes for 2004, but your time is up as of Jan. 1, 2004.
 
In the past, most V codes have been used "only as a supplementary code and should not be selected for use in primary, single-cause tabulations," according to the 2003 ICD-9 book.
 
However, now you can use even more V codes as primary or secondary diagnoses, such as V13.0x (Personal history of other diseases; disorders of urinary system), V13.00 (Unspecified urinary disorder), V13.01 (Urinary calculi) and V13.09 (Other).
 
Coders have always used some V codes as primary diagnoses, but that number of V codes is growing.
 
Technically, you may use any code, including any V code, as a principal diagnosis, but reimbursement for it is another story.
 
The new V-code rules will be helpful only if insurance companies follow the new rules, says Margaret Lamb, RHIT, CPC, of the Great Falls Clinic in Great Falls, Mont. "We've always had to fight for even the ones that are appropriate."