|
|
What's New
Summary of Additions, Deletions and Revisions for Urology
Changes included here reflect newly created and revised CPT® codes that will be of interest to the urologist's practice for the upcoming year. New codes were added for Digestive, Urinary System, Medicine - Drug Administration and Category III Tracking Codes. Codes were revised for Integumentary and Urinary System. Some evaluation & management (E&M) codes were deleted.
The following code descriptions are abbreviated in compliance with AMA copyright provisions. For complete code listings and descriptions, order your 2006 CPT®, ICD-9 and HCPCS books from an AMA-approved vendor.
- New CPT® Codes Effective January 1, 2007
- ICD-9-CM Diagnosis Codes Effective October 1, 2006
- New CPT® Codes Effective January 1, 2006
- Revised CPT® Codes Effective January 1, 2006
- Deleted E&M Codes
- ICD-9-CM Diagnosis Codes: Changes Effective October 1, 2005
New CPT® Codes Effective January 1, 2007
CPT Code Changes for 2007 Affecting Urology
New Codes - Urinary System
CPT has undergone an extensive revision to standardize coding placement under more appropriate headings in an effort to better categorize CPT procedures. An example of the change is the addition of an "exploration" subheading in the testis section of CPT.
Epididymis
Exploration addition of a subheading under Epididymis
54865 |
Exploration of epididymis, with or without biopsy |
This code was created to replace 54825 included in the Excision subheading.
Prostate
Other Procedures
55875 |
Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy
(For ultrasonic guidance for interstitial radioelement application, use 76965)
|
Code 55875 was created without a descriptor change to be included in the new heading of "Other Procedures" in the Prostate subsection. This code replaces CPT code 55859 that was included in the "Excision" subheading in the Prostate section.
55876 |
Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple
|
Bill separately for the image guidance using appropriate radiological modalities.
Radiology Section
76776 |
Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation
|
Revised codes - Urinary System
A parenthetic has been added to indicate that for chemotherapy, both the method (procedure) and the actual drug itself should be reported.
51720 |
Bladder instillation of anticarcinogenic agent (including retention time)
|
Code 51720 was revised to eliminate the word "detention" and replace it with "retention."
52204 |
Cystourethroscopy, with biopsy(s)
|
Code 52204 was revised to indicate that multiple biopsies may be performed during a cystourethroscopic procedure.
54150 |
Circumcision, using clamp or other device with regional dorsal penile or ring block
|
54160 |
Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)
|
54161 |
older than 28 days of age
|
Codes 54150, 54160 and 54161 have been revised to more specifically describe the age of the patient and code 54150 was further revised to specify the type of penile nerve block provided for the circumcision. Code 54152 has been deleted.
Testis - Exploration
Addition of a subheading under Testis to include CPT codes 54550 and 54560
Revision of the Ureter/Pelvis Guidelines
The Ureter/Pelvis Guidelines were revised to better detail the differences between the insertion of temporary ureteral catheters and self-retaining, indwelling ureteral stents during surgical procedures and their respective indications.
Surgical procedures that reference radiological procedures
Cross-references pertaining to renumbered US, CT and MRI guidance codes have been revised due to the renumbering of those codes in the Radiology section.
Deleted Codes
54152 |
Circumcision, using clamp or other device; except newborn has been deleted. To report, use CPT code 54150
|
54820 |
Exploration of epididymis, with or without biopsy has been deleted. To report, use CPT code 54865
|
55859 |
Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy has been deleted. To report, use CPT code 55875
|
Revisions to the following Sections in CPT that affect urology
Evaluation and Management (E&M)
There are changes to the introductory language for the E&M codes with respect to consultations, as well as changes made to the E&M Guidelines in terms of defining, report/results/interpretation.
Radiology
There has been a revision in the definition of a complete US exam of the abdomen, retroperitoneum, with the addition of "real time" to the scan.
Fluoroscopic guidance, CT and MRI guidance for needle placement codes have been renumbered.
A cross-reference was added following 78730 (urinary bladder residual study) referring to 51798 as that should be the code urologists are reporting.
Results/Testing/Reports - There is an addition of a statement to clarify the meaning and relationship of a report to other services provided. The statement relates that "results are the technical component of a service." It goes on to state that testing leads to results, results to interpretation and the report incorporates all these issues. A definition of results, tests, interpretations and reports are added to each main subsection guidelines in the CPT.
Medicine
The therapeutic, prophylactic and diagnostic injections and infusions guidelines have been revised to clarify that the supplies used for the injections and infusions, reported with codes 90765-90775 are separately reported, and not included in the injection and infusion codes. This revision supports information related to reporting for supplies provided elsewhere for the CPT 2006 Drug Administration codes.
For more information, contact Stephanie Stinchcomb in the Practice Management Department through the AUA Coding Hotline at 866-746-4282 Option 2, by fax at 410-689-3907 or by e-mail at codinghotline@AUAnet.org.
 back to top
ICD-9-CM Diagnosis Codes Effective October 1, 2006
The proposed Federal Register released in April 2006 included a listing of new/revised/deleted International Classification of Diseases Coding (ICD-9-CM) diagnosis coding which will be effective October 1, 2006.
New Code(s)
338.0 |
Central pain syndrome |
338.11 |
Acute pain due to trauma |
338.18 |
Other acute postoperative pain |
338.19 |
Other acute pain |
338.21 |
Chronic pain due to trauma |
338.28 |
Other chronic postoperative pain |
338.29 |
Other chronic pain |
338.3 |
Neoplasm related pain (acute) (chronic) |
338.4 |
Chronic pain syndrome |
608.20 |
Torsion of testis, unspecified |
608.21 |
Extravaginal torsion of spermatic cord |
608.22 |
Intravaginal torsion of spermatic cord |
608.23 |
Torsion of appendix testis |
608.24 |
Torsion of appendix epididymis |
780.96 |
Generalized pain |
788.64 |
Urinary hesitancy |
788.65 |
Straining on urination |
Deleted Code(s)
Revised Code(s)
403.00 |
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified |
403.01 |
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease |
403.10 |
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified |
403.11 |
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease |
403.90 |
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified |
403.91 |
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.01 |
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.02 |
Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease |
404.03 |
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease |
404.10 |
Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.11 |
Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.12 |
Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease |
404.13 |
Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease |
404.90 |
Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.91 |
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
404.92 |
Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease |
404.93 |
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease |
600.00 |
Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract (LUTS) |
600.01 |
Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS) |
600.20 |
Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS) |
600.21 |
Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms(LUTS) |
600.90 |
Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS) |
600.91 |
Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS) |
790.93 |
Elevated prostate specific antigen [PSA] |
995.91 |
Sepsis |
995.92 |
Severe sepsis |
995.93 |
Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction |
995.94 |
Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction |
back to top
New CPT® Codes Effective January 1, 2006
Category 1
New Codes: Digestive
45990 |
Anorectal exam under anesthesia, diagnostic |
Use this code if you must perform an anorectal exam for a patient under anesthesia. The surgical diagnostic anorectal exam includes the following: external perineal exam, digital rectal exam, pelvic exam (when performed), diagnostic anoscopy and diagnostic rigid proctoscopy. The operative report must reflect that all of the above was performed in order to bill this service. Append a -52 reduced service modifier to the CPT code if all components were not performed. If any other procedure is performed subsequent to this examination then bill the subsequent procedure only. It would not be appropriate to bill 45990.
New Codes: Urinary System
50250 |
Ablation, open, renal mass lesion(s), cryosurgical, with ultrasound
- (For laparoscopic ablation of renal lesions, use 50542)
- (For percutaneous cryotherapy renal tumors, use code 0135T)
|
Open cryoablation of renal tumor(s) is used to treat renal cancers in a select group of patients who have tumors 4 cm or smaller. Open cryoablation is a viable treatment for patients who have renal cell carcinoma and may have multiple comorbid illnesses, solitary kidneys or renal insufficiency but need to have renal function preserved. Report this code once regardless of the number of lesions ablated.
50382 |
Removal and replacement of internally dwelling ureteral stent, percutaneous approach
- (For bilateral procedure, use modifier 50)
|
Use this code to report removal of a ureteral stent from the bladder and subsequent replacement during the same encounter. The internally dwelling stent is removed by the snare method through a percutaneous approach and another indwelling ureteral stent is then inserted.
50384 |
Removal of internally dwelling ureteral stent, percutaneous approach
- (For bilateral procedure, use modifier 50)
|
Use this code to report removal of a ureteral stent from the bladder. The internally dwelling stent is removed by the snare method through a percutaneous approach.
50387 |
Removal and replacement of externally accessible transnephric ureteral stent requiring fluoroscopic guidance
- (For bilateral procedure, use modifier 50)
|
Use this code when a ureteral stent has been placed in the renal pelvis and urinary bladder and needs to removed and replaced during the same encounter. The ureteral stent accessible externally and is removed using fluoroscopy. A transnephric (through the kidney) approach is used and then another stent is then inserted.
50389 |
Removal of nephrostomy tube, requiring fluoroscopic guidance |
Use this CPT code when a nephrostomy tube is removed using fluoroscopy. If fluoroscopy is not necessary, then do not report this code as it would be considered part of the E&M service.
50592 |
Ablation, renal tumor(s), percutaneous, radiofrequency
- (For bilateral procedure, use modifier 50)
|
Use this code to report percutaneous radiofrequency ablation of renal tumor(s). Report this code once regardless of the number of tumors ablated.
51999 |
Unlisted laparoscopy, bladder
|
This code was added to capture any laparoscopy procedure performed on the bladder not otherwise specified in the CPT book. This code was added for consistency in CPT.
New Codes: Medicine - Drug Administration
For more detailed information, click here to read more information about 2006 Medicare Changes to Drug Administration Codes.
These codes are for therapy, prophylaxis or diagnostic by IV infusion.
90765* |
IV infusion, initial, up to 1 hour |
Example: Use this code to report IV infusion of Zometa. This code is for therapy, prophylaxis or diagnostic infusion push for injection by intramuscular (IM) or subcutaneous.
90766 |
each additional hour, up to 8 hours |
Example: Use this code to report any infusion that may last longer than one hour but no more than eight hours. List this code separately in addition to primary procedure.
90772 |
Injection; subcutaneous or intramuscular |
Example: Use this code to report the injection of an antibiotic or testosterone either by IM or subcutaneous injection.
90774* |
IV push, single or initial substance/drug |
Example: Use this code to report an IV push of gentamycin prior to a cystoscopy with a patient who has a prosthetic knee.
90779 |
Unlisted intravenous or intra-arterial injection or infusion |
This is an unlisted procedure to capture any other therapeutic, prophylactic or diagnostic IV, intra-arterial injection or infusion not available by a specific CPT code
96402 |
Chemotherapy administration; hormonal anti-neoplastic |
This code is used to report the administration of a hormonal anti-neoplastic drug to treat prostate cancer, ie., Lupron/Eligard/Zoladex/Plenaxis/Trelstar by subcutaneous or intramuscular injection.
*Note the initial code that should be reported is the code that best describes the primary, most significant service provided for the patient. The initial infusion/IV push codes 90765 or 90774 should only be reported once per encounter unless a separate IV site must be utilized.
Category III - Tracking Codes
0135T |
Ablation, renal tumor(s), percutaneous, cryotherapy |
This code is used to report cryoablation of renal tumor(s) by percutaneous approach. This is a unilateral code. Report this code once regardless of the number of lesions ablated. Currently, there is no Category I CPT code to capture this procedure. The ultrasonic guidance is not included in this code.
0137T |
Biopsy, saturation sampling for prostate mapping |
Prostate mapping is performed after an initial diagnosis of prostate cancer when a prior needle biopsy (55700) has been performed and has not indicated prostate cancer and a more extensive biopsy method is needed to rule out prostate cancer. This is also used if a traditional biopsy has revealed prostate cancer and patient has elected focused treatment.
back to top
Revised CPT® Codes Effective January 1, 2006
Note: Revisions and parenthetical additions are noted in italics. Deletions are noted with strikethroughs.
Category I
11008 |
Removal of prosthetic material or mesh, abdominal wall for infection
(Insertion of mesh for closure, use 49568)
Note: 49568 is the code for incisional or ventral hernia repair
|
Use this code to report the removal of prosthetic material. A parenthetical note was added to advise coding the insertion of mesh with CPT code 49568.
50688 |
Change of ureterostomy tube via ileal conduit
(If imaging guidance is performed, use 75984)
|
The code was revised to clarify the intent of this code for ureteral tube changes via ileal conduit.
52647 |
Non-contact Laser coagulation of prostate
|
This code was revised to remove the word "non-contact" from the descriptor. This change allows the proper coding of laser fiber technology in the treatment of BPH when the prostate tissue is coagulated.
52648 |
Contact Laser vaporization of prostate
|
This code was revised to remove the word "contact" from the descriptor. This change allows the proper coding of laser fiber technology in the treatment of BPH when the prostate tissue is vaporized.
back to top
Deleted Codes - E&M Services
99261-99263 Follow-up inpatient consultation
99271-99275 Confirmatory consultation
These two series of evaluation and management codes have been deleted and instructions have been added to report other E&M services. Follow up consult codes have been deleted and should be reported with subsequent hospital care codes (99231-99233) or subsequent nursing facility care codes (99307-99310) depending on site of service. Also confirmatory consults were deleted with instruction given to report the appropriate consultation code (99241-99245; 99251-99255). Use the appropriate consultation codes and append a modifier 32 to indicate mandated services by a third party payer.
back to top
Urology ICD-9-CM Diagnosis Codes Effective October 1, 2005
New Urology Diagnosis Codes
585.1 |
Chronic kidney disease, Stage I |
585.2 |
Chronic kidney disease, Stage II (mild) |
585.3 |
Chronic kidney disease, Stage III (moderate) |
585.4 |
Chronic kidney disease, Stage IV (severe) |
585.5 |
Chronic kidney disease, Stage V |
585.6 |
End stage renal disease |
585.9 |
Chronic kidney disease, unspecified |
599.60 |
Urinary obstruction, unspecified |
599.69 |
Urinary obstruction, not elsewhere classified |
V13.02 |
Person history, Urinary (tract) infection |
V13.03 |
Person history, Nephrotic syndrome |
Revised Diagnosis Codes
403.00 |
Hypertensive kidney disease, malignant, without chronic kidney disease |
403.01 |
Hypertensive kidney disease, malignant, with chronic kidney disease |
403.10 |
Hypertensive kidney disease, benign, without chronic kidney disease |
403.11 |
Hypertensive kidney disease, benign, with chronic kidney disease |
403.90 |
Hypertensive kidney disease, unspecified, without chronic kidney disease |
403.91 |
Hypertensive kidney disease, unspecified, with chronic kidney disease |
404.00 |
Hypertensive heart and kidney disease, malignant, without heart failure or chronic kidney disease |
404.01 |
Hypertensive heart and kidney disease, malignant, with heart failure
|
404.02 |
Hypertensive heart and kidney disease, malignant, with chronic kidney disease
|
404.03 |
Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease
|
404.10 |
Hypertensive heart and kidney disease, benign, without heart failure or chronic kidney disease
|
404.11 |
Hypertensive heart and kidney disease, benign, with heart failure
|
404.12 |
Hypertensive heart and kidney disease, benign, with chronic kidney disease
|
404.13 |
Hypertensive heart and kidney disease, benign, with heart failure and chronic kidney disease
|
404.90 |
Hypertensive heart and kidney disease, unspecified, without heart failure or chronic kidney disease
|
404.91 |
Hypertensive heart and kidney disease, unspecified, with heart failure
|
404.92 |
Hypertensive heart and kidney disease, unspecified, with chronic kidney disease
|
404.93 |
Hypertensive heart and kidney disease, unspecified, with heart failure and chronic kidney disease
|
Deleted Diagnosis Codes
585 |
Chronic renal failure |
599.6 |
Urinary obstruction, unspecified |
For a complete list of ICD-9-CM changes, click here
back to top
|
