Urology Coding Alert

Urologists who perform sophisticated laparoscopic procedures such as laparoscopic nephrectomies will be reimbursed fairly by using new CPT codes in 2001. Other new codes include cystourethroscopy codes that are specific to the area in which a stricture is treated and a new code for a partial orchiectomy. The following list of new 2001 CPT codes for urology also includes some of the reasons for creating the codes.

Laproscopy Codes

The new laparoscopic codes were created because of advanced technology that allows for laparoscopic approaches to procedures, explains Michael A. Ferragamo Jr., MD, FACS, clinical assistant professor of urology at State University of New York Medical College in Stony Brook, N.Y. For example, a laparoscopic nephrectomy is a new technique performed in few departments most notably at Jefferson Medical College in Philadelphia. Formerly, this procedure was coded 50546 (laparoscopy, surgical; nephrectomy). But 50546 indicates a simple nephrectomy, not a radical nephrectomy, which is more extensive and covered by the new code, 50545.

50545 laparoscopy, surgical; radical nephrectomy (includes removal of Gerotas fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)

50947 laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement

50948 laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement

50949 unlisted laparoscopy procedure, ureter

Stricture Codes

The new stricture codes will be more widely used than the new laparoscopy codes, says Ferragamo. Until now, urologists have not been able to bill for retrograde approaches (through the ureter via the ureteroscope) to these strictures. Previously, the code used for treating strictures was 50575 (renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy [includes cystoscopy, urethroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent]) with -52 (reduced services) appended. The new codes will make it possible for the urologist to code correctly for a retrograde incision, instead of coding for an antegrade incision through the kidney pelvis.

52341 cystourethroscopy; with treatment of ureteral stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52342 ... with treatment of ureteropelvic junction stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52343 ... with treatment of intra-renal stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52344 cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52345 ... with treatment of ureteropelvic junction stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52346 ... with treatment of intra-renal stricture (e.g., balloon dilation, laser, electrocautery, and incision)

52351 cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic

52352 ... with removal or manipulation of calculus (ureteral catheterization is included)

52353 ... with lithotripsy (ureteral catheterization is included)

52354 ... with a biopsy and/or fulguration of lesion

52355 ... with a resection of tumor

Partial Orchiectomy Codes

The partial orchiectomy code is important because this procedure is technically more sophisticated than a radical orchiectomy, and the relative value units (RVU) for the new procedure should reflect this. A partial orchiectomy preserves the testicle in a patient who has a tumor that can be removed without removing the organ. We understand these tumors better now than we did before, explains Ferragamo. We know that in the case of a benign lesion when we biopsy it and its not cancerous we remove the lesion but leave the rest behind. The only problem is coding it. My feeling is a partial orchiectomy is more sophisticated than a complete orchiectomy, because it requires more dissection and more finesse, he says. In the past, however, the only coding option for urologists performing a partial orchiectomy had been to use 54520 (orchiectomy, simple [including subcapsular], with or without testicular prosthesis, scrotal or inguinal approach) with modifier -52 appended. Thats the only way it could have been coded up to this time, says Ferragamo. I would suspect that the RVUs for the partial orchiectomy are greater than those for a simple or radical orchiectomy.

54522 orchiectomy, partial

54512 excision of extraparenchymal lesion of the testis

The way nephrectomies work a partial receives more reimbursement than a complete. The RVUs for 50220 (nephrectomy, including partial ureterectomy, any approach including rib resection) are 29.90; for 50240 (nephrectomy, partial) the RVUs are 38.17.