Urology Coding Alert

Question:

Texas Subscriber

You should report CPT 38589 (Unlisted laparoscopic procedure, lymphatic system) as there is no specific CPT^® code for this laparoscopic procedure.

When you submit an unlisted code you should always include a cover letter with your claim explaining that you have searched the 2012 active CPT^® manual and found no specific code for the procedure your urologist performed, and therefore, you chose an unlisted procedure code. Use simple, straightforward language to explain exactly what the urologist did, and why an unlisted code fits best.

Documentation tip: Ask your physicians to include information at the top of the operative note explaining the procedure and benchmarking it to a comparable procedure and its CPT^® code to assist the payer in setting a reimbursement fee. You also can provide this information in your covering letter to the payer.

The Medicare Physician Fee Schedule does not include unlisted procedure codes, so the codes do not have assigned fees or global periods. When you submit an unlisted code, suggest a fee by comparing the procedure your surgeon completed to a similar procedure with a "real" CPT code and an established reimbursement value. In this case, benchmark with 38780 (Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes [separate procedure]), an open retroperitoneal node resection.

Best bet: Submit your claim electronically with a short description of the procedure in the electronic equivalent of box 19 of the CMS-1500 form. Follow up with the covering letter and operative report and documentation including a note stating that you are sending "documentation" not a duplicate claim. Filing electronically proves you submitted the claim in a timely manner.