Urology Coding Alert

Question: My physician does EPS (express prostatic secretion) on several patients. He uses methylene blue to look at the secretion under the microscope, which is not the right kind of ink to charge for a wet mount or a prostate smear. Is there any code we could use for the procedure? It would be nice to be able to get paid for it, but we may have to just document it and incorporate it into the E/M code. Can you give me any insight into this unusual procedure?

Arkansas Subscriber

Answer: The procedure isn't that unusual. Urologists sometimes perform EPS for patients with a diagnosis of prostatitis to determine whether the inflammation is bacterial or non-bacterial, or whether the patient simply has prostatodynia. The patient gives a urine sample beforehand. Then the doctor manually milks the prostate until it secretes, and finally the patient gives another urine sample. The lab reviews the urine containing expressed prostate secretions under a microscope and sends the sample for culture and sensitivity.

There is now no code for prostatic massage to obtain expressed prostatic secretions. The prostate massage is included in your E/M service for that office encounter. As more physicians are recognizing EPS as a better alternative to needle biopsy for obtaining samples and its therapeutic value, however, many coders will report this as 55899 (Unlisted procedure, male genital system) in hopes of obtaining better codes in the future.

Consider: CPT Codes CPT 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi or cell types) is for the smear studied with methylene blue. For a wet mount examination of the secretions, you can use CPT 87210 (Smear, primary source with interpretation; wet mount for infectious agents) or HCPCS Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens), depending on what level of CLIA certificate your lab has.