Urology Coding Alert

Check your 2012 coding update savvy.

Find out if you're set to properly code your urologist's services this year or if you need to brush up on the changes affecting your coding in 2012. Check your answers to the three quiz questions on page 19 against this answer key.

Answer 1: For this scenario, you should report ICD-9 629.31 (Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue).

ICD-9 2012 added two new diagnoses related to implanted vaginal mesh: 629.31 and 629.32 (Exposure of implanted vaginal mesh and other prosthetic materials into vagina).

In the past you would have had to use non-specific codes for this condition, such as 996.76 (Other complications of internal [biological] [synthetic] prosthetic device implant and graft; due to genitourinary device implant and graft) or 996.65 (Infection and inflammatory reaction due to other genitourinary device implant and graft). In fact, now in the ICD-9 manual you will find an excludes note after 996.76 that states "Excludes: complications of implanted vaginal mesh (629.31-629.32)."

Answer 2: You should report 99219 (Initial observation care, per day, for the evaluation and management of a patient ... physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit) for this scenario.

CPT® 2012 added time guidelines to the initial observation care codes 99218-99220. This addition mirrors the 2011 addition of time guidelines to the subsequent observation care codes 99224-99226 (Subsequent observation care, per day, for the evaluation and management of a patient ...).

This change "will open the door to coding based on time, as with the other codes," explains Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. She warns that it will be "important for physicians to remember and document accordingly" if coders are going to choose codes using the time criteria. "Picking the proper code is only as good as the documentation to back it up," Hines adds.

Answer 3: As of Jan. 1, you should be reporting Bladder Test Checks with 86386 (Nuclear Matrix Protein 22 [NMP22], qualitative). This is the new 2012 CPT® code for NMP22 protein testing.

In the past, you report this test using 86294 (Immunoassay for tumor antigen, qualitative or semi-qualitative [eg, bladder tumor antigen]) with modifier QW (CLIA waived test) attached, or more recently, 88299 (Unlisted cytogenetic study).

Note: "Ever since we started billing for the NMP-22, we have always utilized 86294-QW," warns Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind. "Last year I believe reimbursement was approximately $25 per test. I know that industry recommendations were to crosswalk the new code, 86386, to 86294 or 83499 (Hydroxyprogesterone, 20-) based on the cost to perform the test. However, CMS chose to crosswalk it to 82487 (Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere specified), which is not a similar method or cost, so it appears reimbursement now will be less."

"We've yet to bill an NMP-22 in 2012 so I'm not sure if and how we'll be paid," Kater adds.

Breaking news: "NMP22 BladderCheck remains a CLIA waived test" says Teri McArdle, RN, strategic reimbursement project manager of urology operations at Alere in Waltham, Mass. "Medicare has issued a Change Request [#7694] out to all of the Medicare contractors and the message basically states that NMP-22/Bladder Check is a waived test effective January 1 with the new code, 86386."

Best bet: "What we are doing right now is referring all providers to their individual MACs for specific direction and guidance on resubmitting denied claims that are post Jan. 1, 2012 and filing any new claims going forward."

You can read the NMP-22 MedLearn Matters article (MM7694) online at http://www.cms.gov/MLNMattersArticles/Downloads/MM7694.pdf.