Urology Coding Alert

Answer 1: D. This year, CPT added two new codes for ureteral stent removal via snare/capture without cystoscopy:

In this case, because the urologist did not replace the stent, 50386 is the appropriate code to report.

Prior to Jan. 1, you would have reported stent removal code 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) with modifier 52 (Reduced services) because the urologist didn't perform a cystoscopy. Or you could have used just an E/M service code.

Remember: Although the urologist used radiological guidance, you cannot separately report a radiology service code. The new code descriptors specify that they include radiological supervision and interpretation.

Answer 2: C. CPT 2008 revised the old paravaginal defect repair code and introduced two new ones:

For the laparoscopic repair, you would report 57423. Don't report cystocele repair code 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele) because the descriptor for the paravaginal defect repair specifically states that the procedure includes the cystocele repair.

Answer 3: C. When your urologist performs a holmium laser enucleation of the prostate (HoLEP) procedures this year, you'll report 52649 (Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]).

HoLEP is technically different from the other holmium laser prostate vaporizations (such as holmium resection of the prostate, or HoLRP, and holmium ablation of the prostate, or HoLAP).

The details: In this procedure, the urologist uses the holmium laser to totally enucleate the prostatic adenoma into one or two large pieces that float into the bladder when freed completely from the prostatic fossa. Next, the physician uses a separate probe to morcellate the adenomas in the bladder into smaller chips that he can then irrigate from the bladder. This does represent more work than the HoLEP procedure, especially performing a second procedure (morcellation) as well as the laser enucleation.

For HoLRP and HoLAP, you would use 52648 (Laser vaporization of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]).

Code 52647 (Laser coagulation of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed]) represents laser "coagulation" of the prostate, not enucleation, so this code would also be incorrect.

Answer 4: D. CPT 2008 introduced three new telephone service codes:

Although reporting 99442 might seem like the right choice because the urologist spent 17 minutes on the phone discussing the patient's care, the descriptors for these codes specify that you cannot report 99441-99443 within seven days of an E/M service. Therefore, you cannot bill for this telephone call.

Pointer: You can consider the telephone conversation between a physician and patient as a factor when determining a service level for any follow-up related E/M service -- if the physician's document showed how the telephone conversation affected the key components of history, exam and medical decision-making for the future E/M service.

-- Answers reviewed by Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.