Major CPT and ICD-9 Code Changes Coming in 2004
Published on Thu Jan 01, 2004
Read this preview to make sure your office is up-to-date on new laparoscopy and urethrolysis codes Significant changes for urology practices are on the way, including a new urethrolysis procedure (53500) as well as a laparoscopy code (57425) for the new CPT in 2004.
CPT Codes 2004 includes a new code for transvaginal urethrolysis procedures: CPT 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]). If a urologist performs this procedure retropubically - from above - report 53899 (Unlisted procedure, urinary system).
The new manual also includes a code for a laparoscopic colpopexy, 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]), a procedure in which a surgeon suspends the vaginal apex to correct vaginal prolapse.
This new procedure will become more common for urologist and coder alike because it's an improvement on the old transabdominal approach, 57280. Laparoscopic procedures are less invasive and have fewer postoperative problems such as postoperative pain, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, N.Y.
"Also, much less time is needed to heal a large abdominal incision and for a much more rapid return to normal life and work," Ferragamo says.
"Initially the insurance carriers perceived these procedures as less technical, less demanding, and simpler for the surgeon to perform," Ferragamo says. "However, contrary to their opinion, the laparoscopic procedures require a much steeper learning curve and much more skill to perform. Realizing this, the carriers are now reimbursing more for the laparoscopic procedures than for the comparable open operations."
A urologist may do this procedure as part of a repair of the pelvic floor. This procedure may be done by either a urologist or a gynecologist, Ferragamo says.
"Sometimes urologists who do a lot of pelvic-floor reconstruction may want to use that code, but probably that would be used by a gynecologist or a urogynecologist," Ferragamo says. "There are many urologists now doing pelvic-floor reconstruction."
One specialist procedure of interest to urologists is a new guidance method for doing in utero fetal surgery, 59897 (Unlisted fetal invasive procedure, including ultrasound guidance). The code may be new, but the procedure isn't. "Certainly that procedure has been done for more than 20 years," says Michael Harrison, MD, chief of pediatric surgery, director of the Fetal Treatment Center and professor of surgery and pediatrics at the University of California San Francisco.
"We did the first one in 1981," Harrison says. "It has evolved, so it's quite different than it was at the beginning, but it's always been done with ultrasound guidance." Stars Fall in 2004 The new manual also eliminates starred procedures. A star (*) beside a CPT code denotes a relatively minor surgical procedure that may require variable amounts [...]
