Urology Coding Alert

Quick Quiz Answers:
 

Answer 1: A. Medicare directs coders to report CPT 52204 (Cystourethroscopy, with biopsy[s]) just once in 2007. Starting Jan. 1, you should report 52204 just once regardless of the number of biopsy sites or how many biopsy specimens your urologist obtains.

Answer 2: A. When your urologist performs a circumcision on a 1-year-old patient using a C-clamp after administering a dorsal penile block, you should report 54150 (Circumcision, using clamp or other device with regional dorsal penile or ring block). CPT 2007 revised the description of 54150 to include the nerve block. Therefore, you should not report 64450 (Injection,  anesthetic agent; other peripheral nerve or branch) in addition to 54150 on claims dated Jan. 1, 2007, and later.

When a urologist performs 54150 without a dorsal penile or ring block, you should append modifier 52 (Reduced services) to indicate reduced services.

CPT 2007 deleted code 54152 (Circumcision, using clamp or other device; except newborn) and instructs you to use 54150 for all non-surgical circumcisions, regardless of age.

You would use 54160 (Circumcision, surgical excision other than clamp, device or dorsal slit; neonate [28 days of age or less]) for a surgical circumcision of a patient who is 28 days of age or younger.

Answer 3: Established. In this case, the patient is established. Regardless of the fact that the encounters took place at separate locations and involved separate urologists or different problems and diagnoses, because the urologists are of the same specialty and billing under the same group number, the "three-year rule" applies. Had the urologists been of different specialties (e.g., one a general urologist and one a pediatric urologist) -- or if they billed under different provider numbers (were not partners or associates) -- the second urologist may have been able to report the patient as new, as long as she hadn't seen that patient within the previous 36 months.

Answer 4: C. As of Jan. 1, you can't report lymphadenectomy codes 38562 (Limited lympha-denectomy for staging [separate procedure]; pelvic and para-aortic) and 38564 (... retroperitoneal [aortic and/or splenic]) when your urologist performs a radical nephrectomy (50230, nephrectomy ... radical, with regional lymphadenectomy and/or vena caval thrombectomy) and an extended lymphadenectomy.

Remember: These new bundles have a modifier indicator of "0," meaning that these edits cannot be bypassed or broken with any modifier.

Best option: Therefore, if your urologist does perform an extended lymphadenectomy at the time of the radical nephrectomy, you should report 50230 and +38747 (Abdominal lymphadenectomy, regional ...) to indicate that the physician performed an extended node resection.

Answer 5: A. NCCI 13.0 bundles several codes into 57296 (Revision [including removal] of prosthetic vaginal graft; open abdominal approach), including the codes for vaginal examination and removal of vaginal foreign body (57400-57415). Therefore, you should only report 57296 in this scenario.

Note: These edits have a modifier indicator of "1." This means you can override the edits by reporting both codes with a modifier, such as modifier 59 (Distinct procedural service), appended to the bundled code, and expect to be paid on both under the proper clinical circumstances.


Answers reviewed by Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, 2-urogynecologist practice in Indianapolis