Urology Coding Alert
New CPT Prosthesis, Excision Codes Highlight Changes for 2002
"Urologists can no longer use modifier -60 to describe an altered surgical field, which left only the unreliable modifier -22 (unusual procedural services),'' says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, Denver, Colo. Payment using modifier -22 varies widely. The same problem exists with excision codes involving circumcision complications. CPT Codes 2002 also introduces three new codes that will enable urologists to receive proper reimbursement for these procedures. Equitable reimbursement for the excision procedures varies depending on the payer, Page added, noting that sometimes even a payer is inconsistent from one case to the next. The new excision codes will make it easier for urologists to communicate to the payer exactly which procedure was performed.
There are also new codes for sacral nerve stimulation that make it possible for urologists to code for this new treatment for incontinence, approved by Medicare this year.
Penile Prosthesis and Excision Codes Added
There are seven new penile prosthesis codes and one revised code for 2002. These much-needed codes separate removal and repair. "Urologists needed more codes to better fit the different clinical situations," says Michael A. Ferragamo, MD, clinical assistant professor of urology at the State University of New York, Stony Brook.
For example, removing an infected prosthesis requires more work than removing one that isn't infected. A separate code, with higher RVUs, will enable a urologist to receive appropriate payment. Three new excision codes in the penis section are also needed because CPT had no specific codes for these procedures. For example, before 2002, for lysis of adhesions after a circumcision, urologists had to use 54450 (foreskin manipulation including lysis of preputial adhesions and stretching), which is not accurate when the adhesions exist following a circumcision, says Page. Use new code 54162 (lysis or excision of penile post-circumcision adhesions) instead for greater specificity. For an incomplete circumcision that requires repair, use 54163 (repair incomplete circumcision). New code 54164 (frenulotomy of penis) is also needed since there had been no coding alternative.
Sacral Nerve Stimulation Codes Added
The addition of two codes for this method of treating incontinence is timely because CMS recently issued a national policy covering sacral nerve stimulation (see story on page 87). The first, 64561 (percutaneous implantation of neurostimulator electrodes; sacral nerve tranforminal placement), is done percutaneously as a test. The urologist places the implant temporarily; there is no incision. The second, 64581 (incision for implantation of neurostimulator electrodes; sacral nerve transforminal placement), is for the incision made for the permanent implant after the test has proven successful.
Modifiers
Modifier -60 (altered surgical field) has been deleted. Medicare never recognized this code, which was created for 2001. Urologists who perform a procedure that requires extra work due to an altered surgical field, such as scar tissue from previous surgery, must use modifier -22 (unusual procedural services). Modifier -22 has been revised accordingly to eliminate its former reference to modifier -60.
Noteworthy Additions and Revisions
There have been numerous additions and revisions to the CPT codes in the sections on repair, bladder and cystourethroscopy procedures.
Note: New codes appear here in bold type, and revised codes are in plain type.
Kidney: One kidney biopsy code, 50200*, has subsequent notes revised to include new recommendations involving related pathology. This code, which is for a percutaneous renal biopsy, instructs physicians to access code 10022 for fine needle aspiration instead of 88170- 88173 as was the case last year. Physicians are instead referred to 88172 and 88173 of the fine-needle aspirate. Radiological supervision and interpretation of the percutaneous biopsy now includes a reference to 76393 as well as 76003, 76360 and 76942.
Repair: Several repair codes involving what was called "bowel anastomosis'' in CPT 2001 now refer to "intestine anastomosis.'' The revisions in these codes (50810, 50820, 50825 and 50840) do not affect the work performed by the urologist, but physicians should note the change in descriptor.
Bladder: Revisions in bladder codes are mainly geared to making the descriptor more scientific. "Intestine'' or "intestinal'' replaces "bowel'' (51590, 51960) and "calculus'' replaces "stone'' in 51065.
Cystourethroscopy Procedures: New codes in this section include some that are overdue including a new code for cystoscopy with irrigation and evacuation of clots (52001) and a cystourethroscopy with transurethral resection or incision of ejaculatory ducts (52347). Urologists have been performing these procedures for some time although no codes existed.
Destruction
Penile Prosthesis Codes
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