Urology Coding Alert

E/M times change one more time.

You’ll be relieved to learn that next year’s updates to the urology CPT^® codes aren’t overly complex. Indeed, the total number of new, revised, and removed urology codes for implementation in January 2024 can be counted on just two hands.

But you’ll need to prepare for some small yet critical changes to the office/outpatient evaluation and management (E/M) codes that could affect the way you document these encounters moving forward.

Here’s what you should expect to see in urology coding.

Consider These New Category I and III Codes

New CPT^® codes relating to urology appearing in 2024 will be: 52284 (Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when performed). You will also see a revision to 96446 (Chemotherapy administration into the peritoneal cavity via indwelling implanted port or catheter) effective Jan. 1, 2024.

This new Category I code, transitioned from Category III Tracking Code 0499T, will be reported by urologists who perform the mechanical dilation of the urethra using a drug-coated balloon catheter. This procedure is reported for urethral strictures only.

These Category III codes are also being added: 0811T (Remote multi-day complex uroflowmetry [eg, calibrated electronic equipment]; set-up and patient education on use of equipment) and 0812T (Remote multi-day complex uroflowmetry [eg, calibrated electronic equipment]; device supply with automated report generation, up to 10 days).

There have been some applications developed to keep track of a patient’s urine flow while at home by use of digital devices, and the results are reported back to the urologist to determine next treatment options. This Category III Tracking Code was developed to track remote uroflow monitoring setup and device supply.

Coding alert: Be sure to pay attention to the attached note for codes 0811T and 0812T, respectively: (Do not report 0811T, 0812T more than once per episode of care) and (Do not report 0811T, 0812T in conjunction with 51736, 51741, 99453, 99454).

Effective in October 2023 is CPT^® Proprietary Laboratory Analyses (PLA) Code 0407U (Nephrology (diabetic chronic kidney disease [CKD]), multiplex electrochemiluminescent immunoassay [ECLIA] of soluble tumor necrosis factor receptor 1 [sTNFR1], soluble tumor necrosis receptor 2 [sTNFR2], and kidney injury molecule 1 [KIM-1] combined with clinical data, plasma, algorithm reported as risk for progressive decline in kidney function).

Because this is a PLA code, it applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0407U only for the IntelxDKD™ from Renalytix, Inc. The test uses a plasma specimen for an immunoassay (lab test based on antigen/antibody reaction) to detect three biomarkers listed in the code. The test includes an algorithmic analysis using test results and clinical factors to report a risk score for progressive kidney function decline in patients with early-stage chronic diabetic kidney disease.

Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland explains, “You will note that some of the CPT^® codes will have an alphabetic character included in the numeric characters. The different alphabetic characters will describe different types of codes. For example, if a ‘U’ is added at the end of the numeric portion of the code, this describes a proprietary laboratory analyses code as described above applies to a unique lab test. Another code might have a ‘T’ included. Codes with a ‘T’ included describe a Category III CPT^® code. These are tracking codes. Since a particular procedure might not meet all the requirements for a new code, a tracking code might be created to keep track of how many times the procedure is performed during the year.”

Understand the Evolution of E/M Changes

After the extensive changes CPT^® made to the E/M codes and guidelines over the last few years, you’ll be relieved to know that this year’s E/M changes are minimal. But that doesn’t mean they are insignificant. CPT^® has decide to remove the time ranges from both the new and established office/outpatient E/M codes and replace them with a single total time amount, which is the lowest number of minutes in the current range for each code. This time “must be met or exceeded” according to the new wording that now appears in each of the codes’ descriptors.

For example, 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making …) has a current time range of 15-29 minutes. However, beginning Jan. 1, 2024, the provider must meet or exceed 15 minutes of total service time on the date of the encounter for time-based coding, as indicated by the new code descriptor (emphasis added): (… 15-29 minutes of total time is spent on the date of the encounter minutes must be met or exceeded.).

In table form, the changes look like this:

Essentially, “this doesn’t really change how the codes are used, but listing the minimum time instead of a range for each code is probably going to be easier to follow,” says Kelly Loya, CPC, CHC, CPhT, CRMA, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

What Will Happen to G2212?

There may be a resolution to the dispute between CPT^® and Medicare over the prolonged service threshold times. Basically stated, Medicare created their own code, G2212 (Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure …), as AMA/CPT^® viewed prolonged services as beginning at the minimum time for 99205/99215 and the Centers for Medicare & Medicaid Services (CMS) beyond the maximum. Now that the time ranges for 99205/99215 have been replaced by a threshold at the minimum end of the range, it is possible that Medicare may follow CPT^® rules and adopt +99417 (Prolonged outpatient evaluation and management service(s) time … each 15 minutes of total time …) for prolonged services instead. Watch for an update in the next issue of Urology Coding Alert if/when Medicare resolves the issue.

CPT^® has also made one other slight change. This change applies to the nursing facility care codes 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient …) and 99307 (Subsequent nursing facility care …), raising their time thresholds by five minutes to 50 and 20 minutes, respectively. “It will be important for providers to know these new, higher thresholds if they are seeing patients in a nursing facility,” Loya notes.

Note: CPT^® will not be changing the descriptor to 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional). Although a physician, nurse practitioner (NP), physician assistant (PA), or any other nonphysician practitioner (NPP) (considered qualified healthcare professionals [QHPs]) can report this code, CPT^® code 99211 is a way to report E/M services for an established patient provided by other clinical staff members (nurses, medical assistants, etc.).

Direct intervention by the physician or other qualified healthcare professional is not required, but they should be in the office suite when each service is provided. For Medicare requirements, the QHP must have initiated the service as part of a continuing plan of care in which they will be an ongoing participant. There is no level of medical decision making (MDM) or total time required to report this code. Documentation should include sufficient information to support the reason for the encounter and E/M service and any relevant history, physical assessment, and plan of care. The date of service and the identity of the person providing the care should be noted along with any interaction with the supervising QHP.