Urology Coding Alert

Plus, you may finally get paid for cryotherapy renal tumor ablation January is a time to implement new and revised CPT Codes, and urology practices will have a lot to digest this year, including new stent removal codes and bladder aspiration code changes. Don’t delay: One of the biggest changes for urology coders is that you’ll have two codes for stent removals without cystoscopy. Also, there is now a permanent code for cryotherapy renal tumor ablation, and there are new numbers for bladder aspiration. These new codes take effect on Jan. 1, and CPT expects coders to start using them right away. Remember that there is no longer a grace period for you to get used to the new codes.   No Cysto? No Problem Next Year   Good news: Beginning in January, you can stop using modifier 52 (Reduced services) when your urologist removes an internally dwelling ureteral stent without cystoscopy. Old way: Now, when the urologist removes a ureteral stent without cystoscopy, you use stent removal code 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) with modifier 52, says Christy Shanley, CPC, billing manager for the University of California, Irvine, department of urology. The other option has been to report only an E/M service code. New way: CPT 2008 adds two new codes for ureteral stent removal via snare/capture without cystoscopy: 50385 (Removal [via snare/capture] and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation) and 50386 (Removal [via snare/capture] of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation). Do not use the codes when the urologist is removing a stent by means of an attached thread or string, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. "This would be part of your E/M service for that visit," he says. When the physician uses a clamp or other instrument passed through the urethra to grasp the stent and facilitate its removal or exchange, you’ll use the new codes. Most often the physician would perform this under radiological guidance, which is included in the new CPT codes, Ferragamo says.   Upgrade Your Cryo Ablation to Category I   Say goodbye to temporary code 0135T (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy). January’s changes delete this code and replace it with 50593, which has the same descriptor. "I am glad they are getting a code for this," Shanley says. Her office usually collects an advance beneficiary notice (ABN) form from patients before performing a cryotherapy renal tumor ablation. "Only a small portion of [...]