Urology Coding Alert

"The catheter codes have been long overdue for specification," Thacker says. "It was nearly impossible to accurately communicate the purpose of the catheter procedures when done in addition to another procedure using the old codes."

The old catheterization codes were replaced to differentiate between indwelling and nonindwelling catheterization, says Connie Copeland, coder and HIPAA compliance officer for Urology Professional Association in Tupelo, Miss. 53670 did not do this, she adds.

Copeland proffers the following example of when to use 51701: A female patient states she doesn't feel as if she empties completely when she voids. "In order to determine how much urine she is retaining, a catheter would be inserted to drain her bladder and measure the amount of urine drained."

But if a patient is seen in acute urinary retention, she says, a temporary indwelling Foley catheter is inserted and the patient leaves with the catheter in place. This requires code 51702.

Suppose the same patient presents in acute urinary retention, but several attempts to insert a Foley catheter fail, and a guide is required to insert the catheter. In this case, you are going to need code 51703, Copeland says.

Remember, with the addition of these three catheter codes comes the deletion of the urethral catheterization codes 53670* (Catheterization, urethra; simple) and 53675* (complicated [may include difficult removal of balloon catheter]).

New catheter codes have emerged as a result of problems with the differences between the previous CPT catheter codes and the Medicare HCPCS catheter codes, hypothesizes Wendy Dicus, CPC, coding supervisor for Alaska Billing Services Inc. in Anchorage. Codes 53670 and 53675 "always conflicted with Medicare's P9612 and G0002 codes," she says.

Dicus sees the need for the new catheter codes because of the difficulty associated with assigning Medicare patients proper catheter codes, especially because "temporary" was never part of the description of a CPT catheter code before now. "With these new CPT codes, I would expect Medicare to delete G0002," Dicus says, because the further defining of the types of catheters brings recognition to the difference in catheters that is already recognized by Medicare.

But according to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, "You will still be able to use both P9612 (Catheterization for collection of specimen, single patient, all places of service) and G0002 (Office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]) for Medicare patients because they have yet to be deleted." But watch for updates to the 2003 Medicare Physician Fee Schedule Data Base that may delete these codes for Medicare reimbursement in the near future.

An addition to the vaginal hysterectomy codes gives urology coders more detailed options for coding hysterectomy surgeries that involve the Marshall-Marchetti-Krantz procedure for urinary incontinence:

Suppose a 50-year-old woman with urinary incontinence presents for a combined vaginal hysterectomy procedure and incontinence-correction procedure. The patient's gynecologist performs the hysterectomy, and your urologist corrects the incontinence using the Marshall-Marchetti-Krantz procedure. If the patient's uterus weighs more than 250 grams, both the gynecologist and the urologist should report the new code, 58293, with modifier -62 (Two surgeons).

If the uterus weighs less than 250 gram, use revised code 58267 (Vaginal hysterectomy, for uterus 250 grams or less; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control), also with modifier -62.

A new urodynamics code also made the cut, placing 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) on the CPT map. Prior to the addition of this code, many coders used 76775 for simple bladder scans, Dicus says. She has been waiting for this equivalent to Medicare's G0050 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound), which is scheduled to be deleted from HCPCS 2003.

As with the previous Medicare HCPCS code G0050, coders should note that 51798 has a strictly technical component and does not account for any physician professional component. One cannot and should not use modifier -26 (Professional component) or -TC (Technical component) with 51798.

A new endoscopy code also has been added to CPT 2003: 50562 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor) becomes available to urology coders at the start of next year. Don't confuse 50562 with 52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor), which indicates a ureteroscopic resection of a ureteral or pelvic tumor, Ferragamo warns.

CPT 2003's code revisions clear up any confusion about the precise location of three urologic procedures: 49905, 52354 and 52355.

A fourth revised cystourethroscopy code, 52001, used for the evacuation of clots, has been changed to include the more detailed description "multiple obstructing clots."

It is nice to have "multiple" included in the definition of 52001 because some physicians expect coders to report 52001 for each clot evacuated, Dicus says. For example, when 52001 did not include "multiple," some physicians assumed that the evacuation of three clots could be reported 52001, 52001-59 (Distinct procedural service), 52001-59 for maximum reimbursement. The revised definition clarifies that this is not proper coding.

When trying to identify in the documentation whether the clots can be classified as obstructive, check to see if the patient presented in urinary retention, Perkins and Copeland says.

Dicus offers other key phrases that indicate clots are obstructive such as "clot retention" and "clot found at bladder neck." "If these key words are not present [in the operative report], I would code 51700 for bladder irrigation," she says. Additional revisions to urology codes include: