Urology Coding Alert

Test yourself with these 5 questions about the edits, deletions and additions

If you’re still trying to get a grip on the Jan. 1 CPT Changes, take this quiz. These questions will test just how well you understand the new drug administration changes and the new cryoablation and renal pelvis catheter codes. Turn to page 14 to see the answers. Hint: You can find all the quiz answers in the CPT Updates 2006 articles in the December 2005 issue.

Question 1: True or false: You can expect higher reimbursement using the new permanent drug administration codes 90765, 90772 and 96402 than you did with the G codes you used before.

Question 2: If your urologist administers a Depo-Testosterone injection, what code should you report for the drug administration?

A. G0347
B. 90765
C. 90772
D. 96402
E. None of the above

Question 3: Your urologist performs a percutaneous radiofrequency renal ablation in the hospital on the patient’s right side, using magnetic resonance imaging (MRI) to monitor the tumor’s response to the percutaneous radiofrequency. What is the correct way to code this procedure?

A. 50592
B. 50592-50
C. 50592 and 76940-26
D. 50592 and 76394-26
E. None of the above

Question 4: Which CPT code should you report when a urologist removes a prosthetic vaginal graft via a vaginal incision?

A. 57267
B. 57295
C. 58999
D. 50688
E. None of the above

Question 5: An internist requests that a urologist perform a consult in the hospital for a patient with an elevated prostate specific antigen (PSA, 790.93). Later during the same inpatient stay, the urologist checks again on the patient and provides subsequent urological care. Which of the following coding scenarios might be appropriate for reporting these visits in 2006?

A. 99253 for the first visit and 99261 for the second
B. 99261 for the first visit and 99231 for the second
C. 99253 for the first visit and 99231 for the second
D. All of the above
E. None of the above


Answer 1: False. Urologists will be paid about 7 percent less than last year when using the new administration codes. For example, based on the 2005 and 2006 physicians’ standard unadjusted fee schedule, instead of a $36.69 reimbursement for G0356, you’ll receive about $34.01 for code 96402 in 2006, which is about 7.3 percent less.

Remember, this is based on the loss of the 3 percent transitional increase that physicians received in 2005 (discontinued in 2006), the change in the conversion factor, minor changes in the relative value units (RVU), and the geographic practice cost indices (GPCI).

Recent events: In the near future a drop in the drug administration fees will be offset somewhat if Congress enacts legislation that will freeze 2006 fees at the 2005 fee schedule level.

Answer 2: C. You should report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for therapeutic or diagnostic injections, such as Depo-Testosterone, that your urologist administers.

In urology, you usually use 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for Zometa injections and 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic) for Lupron, Zoladex, and other anti-neoplastic hormonal injections. Code G0347 (Intravenous infusion, for therapeutic/diagnostic; initial, up to one hour) is the old G code for Zometa infusions.

Answer 3: D. You should report 50592 (Ablation, one or more renal tumor[s], percutaneous, unilateral, radiofrequency) for the ablation. In this scenario, you would also report 76394 (Magnetic resonance guidance for, and monitoring of, visceral tissue ablation) for the MRI monitoring since 50592’s code descriptor does not specify any intraoperative radiological inclusions.

Append modifier 26 when the patient undergoes the radiological procedures in the hospital. The carrier will then pay the urologist the professional fee only. The hospital collects the technical fee for the ownership of the equipment.

Answer 4: B. As of Jan. 1, you should use 57295 (Revision [including removal] of prosthetic vaginal graft, vaginal approach) for the revision or removal of a prosthetic vaginal graft.

Code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach) is for the insertion of a prosthetic vaginal graft. Before CPT added 57295, you were forced to report unlisted-procedure code 58999 (Unlisted procedure, female genital system).

CPT revised 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) for 2006, but this code doesn’t relate to vaginal grafts.

Answer 5: C. Given the appropriate levels of service, 99253 (Initial inpatient consultation for a new or established patient ...) and 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) would be appropriate codes for the scenario given.

CPT 2006 deleted follow-up consultation codes 99261-99263 (Follow-up inpatient consultation for an established patient ...). You should now report initial consultations in the inpatient setting using 99251-99255, and follow-up inpatient consultations or subsequent hospital care using subsequent hospital care codes 99231-99233.

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