Urology Coding Alert

Caution: 64555 is not the best code choice anymorePercutaneous tibial nerve stimulation (PTNS) is be-coming a more common procedure for urologists who treat urinary disorders. If coding for this new technique has left you scratching your head, you're not alone. Follow these three steps to ensure your coding keeps up with your urologist's ventures into this emerging technology.Tip 1: Understand the ProcedureWhen you hear the description of PTNS, it's hard to imagine that urologists use this treatment. After all, the physician inserts the needle into the patient's ankle. The treatment, however, has proven effective for treatment of conditions such as urinary frequency, urgency and urge incontinence, says Kathryn Copeland, MD, urogynecologist at St. Vincent's Hospital in Indianapolis.How it works: "Patients come to the office and have a small needle (27 gauge -- like an acupuncture needle) inserted into the muscle above their medial ankle," Copeland explains. The physician connects the needle "to a small electric stimulator that sends a light electric current through the needle near the posterior tibial nerve," she adds. After the physician determines the needle is in the proper place, the patient sits for 30 minutes of electrical nerve stimulation.Choosing a diagnosis: Urologists and urogynecologists use PTNS to treat many urinary disorders, such as overactive bladder. Some of the ICD-9 codes you'll use when reporting PTNS include 788.30 (Urinary in-continence, unspecified), 788.31 (Urge incontinence), 788.33 (Mixed incontinence [male] [female]) and 788.41 (Urinary frequency).Tip 2: Report the Procedure With Just 1 CodeCoding experts used to suggest reporting 64555 (Percu-taneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) for the posterior tibial nerve needle placement and stimulation.Additionally: Experts also recommended reporting 95971 (Electronic analysis of implanted neurostimulator pulse generator system ...; simple spinal cord, or peripheral ... neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming), for the urologist's programming of the neurostimulator, along with 64555, says Copeland.However: Recently, the American Urological Association (AUA) reviewed billing and coding practices for PTNS, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook. The AUA has made the following recommendations:• Do not use 64555 as this appears inappropriate for the services provided by PTNS.• Instead, use 64999 (Unlisted procedure, nervous system).• Do not bill 95971 since there doesn't appear to be any type of programming that is part of the overall procedure.• PTNS is an office procedure. Urologists should not perform the procedure at -- or bill for it from -- an ambulatory surgical center or hospital setting."For the present, I would suggest that the above AUA recommendations and policies be accepted and followed until a specific CPT code for PTNS is established," Ferragamo says.Warning: Some payers still consider PTNS for voiding dysfunction to [...]