Urology Coding Alert

CPT Codes 2003, which goes into effect Jan. 1, 2003, brings significant additions to urology coding practice, including a long-awaited laparoscopic partial nephrectomy code. Not one, but two laparoscopic kidney procedure codes were added to CPT's Urinary section: 50542 (Laparoscopy, surgical; ablation of renal mass lesion[s]) and 50543 ( partial nephrectomy)

"We've been waiting for more laparoscopy codes to be added," says Diane M. Perkins, CPC, a urology coder with Eastern Connecticut Urology in Norwich. "In the past we've had to use the nonspecific, unlisted codes and send a detailed operative report when laparoscopic ablation of renal lesions and partial nephrectomies were performed. It wasn't that we were having problems getting these paid, because almost everything we do is precertified, but it is nice to have codes that will accurately reflect the skill and work intensity that laparoscopic procedures require."

"When billing unlisted-procedure codes the payment is noticeably reduced from similar listed procedures," says surgical urology coder Karen Thacker, CPC. "We perform both laparoscopic ablation of renal masses and laparoscopic partial nephrec-tomies frequently and have spent a great deal of time and effort to obtain adequate reimbursement for these procedures." The addition of the new laparoscopy codes should alleviate some of the effort required when submitting unlisted-procedure codes. Flush Your Old Catheter Codes Finally, three new bladder catheter codes will provide coders with a plethora of options when determining the codes that best reflect the exact anatomic location of the catheter insertion, the type of catheter inserted and, in some cases, the reason for the bladder catheter: 51701 Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine) 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley) 51703 complicated (e.g., altered anatomy, fractured catheter/balloon). "The catheter codes have been long overdue for specification," Thacker says. "It was nearly impossible to accurately communicate the purpose of the catheter procedures when done in addition to another procedure using the old codes." The old catheterization codes were replaced to differentiate between indwelling and nonindwelling catheterization, says Connie Copeland, coder and HIPAA compliance officer for Urology Professional Association in Tupelo, Miss. 53670 did not do this, she adds. Copeland proffers the following example of when to use 51701: A female patient states she doesn't feel as if she empties completely when she voids. "In order to determine how much urine she is retaining, a catheter would be inserted to drain her bladder and measure the amount of urine drained."

But if a patient is seen in acute urinary retention, she says, a temporary indwelling Foley catheter is inserted and the patient leaves with the catheter in place. This requires code 51702. Suppose the same patient presents in acute urinary retention, but several [...]