Urology Coding Alert

Skipping over temporary Category III code changes will cost you.

While the biggest CPT^® 2023 changes you’ll need to focus on are the percutaneous nephrostolithotomy (PCNL) code revisions covered in the article “Prepare Now for PCNL, Prostatectomy Code Changes Coming Your Way in January” in Urology Coding Alert, Volume 24, No. 10, you’ll leave money on the table or face denials if you stop there.

Changes to coding options for mesh implantation, laparoscopic prostatectomy, transperineal laser ablation, and suture removal, effective Jan. 1, 2023, are all important updates for urology coders to review. Read on to set your practice up for coding success in the new year.

Consider 15778 With Fournier’s Gangrene Debridement + Mesh

CPT^® 2023 introduces code 15778 (Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma). “This can be used with [treatment for] Fournier’s gangrene (necrotizing fasciitis) of the genitals,” says Stephanie N. Storck, CPC, CCS-P, a urology coding consultant in Glen Burnie, Maryland.

Code 15778 “will be a great addition when urologists are dealing with soft tissue infections of scrotal and perineal tissue that frequently require debridement and delayed closure,” says Melanie Scott, CPC, CRHC, CPPM, CMPE, director of operations at Five Valleys Urology in Missoula, Montana. “However, most of the time this code will probably be utilized by general surgeons after the initial care by the urologist depending on the severity of the infection.”

Add 55867 to Your Lap Prostatectomy Choices

When your urologist performs a laparoscopic prostatectomy in 2023, you’ll have a new code to use: 55867 (Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed).

“The addition of a code for a simple laparoscopic prostatectomy only makes sense,” Scott says. “With a code assigned, billing and coding questions like ‘should I use an unlisted code?’ or ‘should I append a modifier to the existing laparoscopic radical prostatectomy code?’ are no longer a problem. Less confusion, more accurate coding!”

Reimbursement: The 2023 Medicare Physician Fee Schedule (MPFS) proposed rule states that the proposed work relative value units (RVUs) for 55867 are 19.53. The proposed rule also adds that existing laparoscopic prostatectomy codes 55821, 55831, and 55866 will have reductions in their work RVUs as follows:

• 55821 currently has a work RVU value of 15.76, with a proposed reduction to 15.18 in 2023.
• 55831 currently has a work RVU value of 17.19, with a proposed reduction to 15.60 in 2023.
• 55866 currently has a work RVU value of 26.80, with a proposed reduction to 22.46 in 2023.

Focus on Global Period for 15851-+15854 Changes

If your urologist performs suture or staple removal outside of the global period of another procedure — for example, for a patient who had surgery in another town — you’ll want to take note of some suture removal code changes.

On Jan. 1, CPT^® will delete 15850 (Removal of sutures under anesthesia (other than local), same surgeon) and will revise the following codes as indicated below (emphasis added):

• 15851 (Removal of sutures or staples under requiring anesthesia (ie, general anesthesia, moderate sedation)(other than local), other surgeon)
• +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code))
• +15854 (Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code))

“The removal codes could be used by urologists in the future when suture removal is outside of the global period,” Storck says.

Caution: You won’t be able to report these codes, even with the changes, for most procedures your urologist performs. “Most of the surgeries that require sutures or staples have a 90-day global period and the removal is part of the surgical [package]. The only time I could see this being utilized is if the surgery was performed out of town or out of state and the patient returns to their urologist closer home for staple removal,” Scott explains.

Don’t Forget Category III Changes

If your urologist performs transperineal laser ablation for benign prostatic hyperplasia, you’ll have a new Category III temporary code to start using on Jan. 1: 0714T (Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance).

You may also use new Category III code 0739T (Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/ catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation) if your urologist performs this procedure in conjunction with the radiation oncologist. The other new urology-related temporary code that will be used by the radiation oncologist, Storck says, is 0738T (Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed magnetic resonance imaging (MRI) examination).

Note: CPT^® 2023 also deletes 0499T (Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed) so stop using that code if you have been reporting it.

Keep in mind: Category III codes are “temporary codes for emerging technology, services, procedures, and service paradigms,” CPT^® guidelines state. These codes are carrier-priced, so reimbursement, if any, will be up to your individual payers.

Although coverage and payment for Category III codes is not guaranteed, you should not try to get around that by using an unlisted code or other Category I code. “If a Category III code is available, this code must be reported instead of a Category I unlisted code,” according to the CPT^® guidelines.

The reason is that “data collected from Category III codes is crucial to establishing Category I codes,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services. When you use the Category III code, you help show that providers are using the new service or procedure, which can help support changing the Category III code to a more permanent Category I code.