Urology Coding Alert

Tip: Review the CMS Web site to update charge forms

You'll have a little less time to adjust to the new ICD-9 and HCPCS codes from now on. CMS has scrapped the 90-day grace period you once had for implementing new codes, according to two Feb. 6 CMS transmittals (Nos. 89 and 95). The new rule, however, shouldn't cause your urology practice many problems, coding experts say.

The grace period allowed providers "to ascertain the new codes and learn about the discontinued codes," CMS says. But HIPAA's "transaction and code set rule" mandates that physicians and practices report codes that are valid at the time the physician rendered the service.

The result: You will have to begin using new and revised ICD-9 Codes when CMS introduces them on Oct. 1, 2004. You will not have 90 days to continue using the old codes. For CPT Codes and HCPCS Level II Codes , the new grace-period ruling becomes effective on Jan. 1, 2005.

Get a Grip on the New Rule

Follow these two examples for coding under CMS' new rule.

Example #1: In 2003, there was only one way to code a diagnosis of BPH: with ICD-9 code 600.0 (Hyperplasia of prostate; hypertrophy [benign] of prostate). With the 2004 codes, however, Medicare introduced a mandatory fifth-digit classification to specify whether the BPH was causing urinary obstruction. The new codes, 600.00 (Hypertrophy [benign] of prostate without urinary obstruction) and 600.01 (Hypertrophy [benign] of prostate with urinary obstruction), became effective Oct. 1, 2003.

Under the grace period, most Medicare carriers would accept deleted code 600.0 until Dec. 31, 2003. Without the grace period, however, you should report 600.00-600.01 on Oct. 1, or your Medicare payer would probably deny your claim.

Example #2: Remember that CMS' grace-period elimination also applies to new CPT and HCPCS codes. For instance, on Jan. 1, 2004, CPT introduced CPT 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]) for transvaginal urethrolysis. Previously, you would have used 57287-52 (Removal or revision of sling for stress incontinence [e.g., fascia or synthetic]; reduced services) for urethrolysis following a sling procedure, or CPT 52285 (Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp[s] of urethra, bladder neck, and/or trigone) for urethrolysis for scarring secondary to infection. You had until March 31, 2004, to begin reporting 53500. But next year you will have to begin assigning new codes on Jan. 1, 2005, the day they take effect.

Spread the Word About New Codes

What to do: You shouldn't encounter many coding difficulties or denials without a grace period as long as you update your encounter forms by the ICD-9 and HCPCS deadlines, says Melanie Witt, RN, CPC, MA, an independent coding consulting in Fredericksburg, Va.

The Federal Register usually publishes new codes well in advance of their release, so you should have enough time to make the changes, she adds.

"You need to let your staff know that there is a set of new codes," Witt says.

You can even handwrite the new codes in the encounter form's "Other" blank, she says.

Download: After the Federal Register publishes the codes, the CMS posts them on its Web site. New, revised and discontinued ICD-9 codes should appear at http://www.cms.hhs.gov/medlearn/icd9code.asp sometime after May 1, 2004. CMS will publish the updated CPT and HCPCS codes at http://www.cms.hhs.gov/providers/pufdownload/anhcpcdl.asp at the end of October 2004.

Beware: Medicare will be ready to accept these codes the day they become effective, but some private carriers may not be. If a carrier denies a correct code, talk to the provider representative and alert him to the new code.