Urology Coding Alert

Hint: You will see new code 53451 in 2022.

When CPT^® 2022 becomes effective on Jan. 1, 2022, you’ll see several new periurethral transperineal adjustable balloon continence device codes, hypospadias revisions, and evaluation and management (E/M) additions and revisions.

Keep your urology claims in tip-top shape by staying on top of the following code additions and revisions you will see next year.

Read on to learn more.

Focus on New Balloon Continence Device Codes

In 2022, you will gain several new codes for periurethral transperineal adjustable balloon continence device insertion. They are as follows:

• 53451 (Periurethral transperineal adjustable balloon continence device; bilateral insertion, including cystourethroscopy and imaging guidance). Note: You should report code 53451 for a bilateral device insertion, per the code descriptor.
• 53452 (… unilateral insertion, including cystourethroscopy and imaging guidance). Note: You should report code 53452 for a unilateral device insertion, per the code descriptor.
• 53453 (… removal, each balloon). Note: You should report code 53453 when your urologist removes a periurethral transperineal adjustable balloon continence device.
• 53454 (… percutaneous adjustment of balloon(s) fluid volume). Note: You should report code 53454 for the percutaneous adjustment of a periurethral transperineal adjustable balloon continence device insertion.

Don’t Miss Hypospadias Revisions

You will also receive several hypospadias code revisions, although some of these revisions will be very minor. For example, look at code 54340 (Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple). (Emphasis added.) As you can see, the “s” in “complications” will be put into parenthesis. You will also see this change for code 54344 (Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft).

Additionally, you will gain some revisions to code 54348 (Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring extensive dissection and urethroplasty with flap, patch or tubed graft (includes ing urinary diversion, when performed)). (Emphasis added).

As you can see, the word “includes” will change to “including” in 2022. Also, “when performed” has been added to the descriptor for 54348.

Lastly, you will get some revisions to code 54352: (Revision of prior hypospadias repairRepair of hypospadias cripple requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as flaps or grafts).

As you can see, code 54352 will change to a revision of a prior hypospadias repair in 2022.

Remember when repairing hypospadias complications from previous repairs, recent or in the distant past, bill one of the above hypospadias repair codes, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Discover New E/M Codes

You will also receive a new chronic care management (CCM) code in 2022: +99437 (Chronic care management services with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline …)

Additionally, you will gain several new principal care management service codes. They are as follows:

• 99424 (Principal care management services, for a single high-risk disease, with the following required elements:
  • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
  • the condition requires development, monitoring, or revision of disease-specific care plan … first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)
• +99425 (Principal care management services, for a single high-risk disease, with the following required elements:
  • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
  • the condition requires development, monitoring, or revision of disease-specific care plan … each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure))
• 99426 (Principal care management services, for a single high-risk disease, with the following required elements:
  • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
  • the condition requires development, monitoring, or revision of disease-specific care plan …first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.)
• +99427 (Principal care management services, for a single high-risk disease, with the following required elements:
  • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
  • the condition requires development, monitoring, or revision of disease-specific care plan … each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure))

Don’t miss: Code +99425 is an add-on code you can use with primary code 99424. Also, code +99427 is an add-on code you can use with primary code 99426.

Don’t Miss These E/M Revisions

You will also see numerous E/M revisions in 2022.

For example, the descriptor for code 99211 will gain some changes: 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.) (Emphasis added.)

You will also seem some changes to code 99491 (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
• chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
• comprehensive care plan established, implemented, revised, or monitored; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.) (Emphasis added).

Also, codes 99490 and 99487 will receive a small revision. The word “that” will be added to the code descriptors. For example, 99490 will now be (Chronic care management services with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• chronic conditions that place the patient at significant risk…). (Emphasis added.)