Urology Coding Alert

Plus: Learn how to incorporate 2007's renumbered codes For urology coders, the 2007 CPT revisions will bring several clarifications that will help make your job easier. You'll have a clear answer on how to report multiple biopsies via cystourethroscopy, and your search for tricky procedures, such as exploration of the epididymis, just got easier.

Take a look at the changes you'll need to focus on come Jan. 1 to keep your urology practice on track. Watch Out for the New 'S' A urologist performing multiple biopsies during a cystourethroscopy used to be a coding nightmare ¾ but not anymore. CPT Codes 2007 clarifies how you should report these multiple biopsies. Starting Jan. 1, you should report 52204 (Cystourethroscopy, with biopsy[s]) just once.

In the past, you could report each separate biopsy using CPT 52204 multiple times, and many carriers would pay on each one, experts say. That won't be the case anymore.

What changed: What seems like a very minor change -- the addition of "(s)" -- actually has a large impact on how you might code these types of procedures. Regardless of the number of biopsy sites or how many biopsy specimens your urologist obtains, you'll report one instance of 52204.

"The change of the text for 52204 makes a long disputed issue clear," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis. "The addition of (s) to 52204 solves a long disputed issue about the use of this code multiple times for multiple biopsy sites."

Tip: If your urologist performs a significant number of biopsies due to the nature of the procedure, you may be able to report 52204 with modifier 22 (Unusual procedural services) to show that the physician spent extra time and effort on the procedure. Use 55876 for Fiducial Markers

One of the most positive additions for urology coders is new code 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple).

This new code is necessary because urologists are already performing the relatively new procedure of placing markers in the prostate to facilitate radiation therapy to the prostate. Previously, you had to use an unlisted code to report this procedure (55899, Unlisted procedure, male genital system).

"I am assuming we'll be able to utilize this code for our gold seed placements, and what a relief that will be!" says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind.

"CPT 55876 is a very welcome addition!" Hause says. "We are anxious to see how much is reimbursed." In New York, area #2, Medicare will reimburse $170.78 when the urologist performs the procedure in the office and $124.15 when performed in [...]