Focused CPT Management Series:
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Urology/Male/Female/Neurology and Sense
Organs
Karen Scott, MEd, RHIA, CCS-P, CPC
Karen Scott Seminars and Consulting
Memphis, TN
kscottseminars@comcast.net
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All CPT codes and descriptions are copyright protected by the AMA
Agenda
Discussion of the common Coding Problem
Areas
Factors that impact APC Payment
Training issues for physicians and other
documenting personnel
Urinary System
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Biggest problem encountered is anatomy
Two kidneys lead to two tubes called ureters
Which lead to the bladder
One tube leading out of the bladder to the
outside of the body called urethra
• Very easy to pick wrong code based on
similar wording
• Ureteroscopy/Urethroscopy
Inpatient vs. Outpatient
procedures
• Lots of inpatient procedures right in the
middle of the codes for outpatient
• Such as x0075 Removal of large
staghorn calculus-Inpatient
A few Outpatient procedures
• X0020, 21 Abscess drainage from
kidney area open (APC 162 $1690.26)
vs. percutaneous (APC 0037, $892.96)
• x0080, 81 Percutaneous kidney stone
removal- APC 0429, $3026.08)
– Coded by size only
– Lots of procedures included in base code
Stents
• Indwelling/Internally Dwelling vs.
Externally Accessible
• Put in for usually week or more to keep
ureter open after surgery or to
help stone fragments pass easier
– “Double J Stent”-very common
– Codes: Change out vs. just removal,
insertion under other sections
– Coded by approach
– Unilateral
– Radiology portion of codes included
Laparoscopic Vs. Open
procedures
• Most of the open procedures on the inpt only
list
• Kidney
• X0541 Destruction kidney cysts 130
$2502.89
• x0542 destruction of renal lesions 174
$7,908.83
• x0543-removal of lesion; partial removal of
kidney 131 $3,060.10
• X0544 pyeloplasty 130 $2,502.89
• X0545 Radical nephrectomy Inpt. procedure
Kidney Endoscopic
Procedures
• APC Placement depends on what
surgical procedures are done
• 50551, 55, 62, 70, 72, 74 APC 160,
$476.31
• 53, 57, 61 APC 162 $1690.26
• 50576, 80 APC 161 $1241.45
• 50575 APC 163, $2369.29
Bladder Drainage
• 51100 Aspiration of bladder by needle
– Through skin to remove urine from bladder
– APC 164 $123.51
• 01 Aspiration of bladder by trochar/catheter
– APC 126 $68.23
• 02 Including insertion of catheter
– Catheter is placed through opening
– APC 165 $1323.47
– Can code radiology separately
Bladder
• Insertion of non-indwelling catheters
51701-51703
– 51701-for left over urine X 340 $42.69
– 51702-temporary catheter, such as Foley
– 51703-Complicated insertion of temp.
catheter T126 $68.93
Urodynamics
• Measurement of urine flow, residuals
• Simple vs. complex
– Depends on type of equipment used
Cystourethroscopy
• Many times are inclusive in other
procedures
• Different codes dependent on what is
removed
– Stone, lesion, tumor, size (small, medium, large)
• 52001 watch wording- included
“multiple obstructing” clots
Ureter and Pelvis
• Indwelling stent coded to 52332 APC
162 $1690.26
– Gibbons/Double-J
• 52354, 52355- shows specific location
of lesion/tumor APC 162
OP Report
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Preoperative Diagnosis: BPH
Postoperative Diagnosis: Same
Procedure:
TURP, Cystoscopy
74 year old white male presenting with unable to void, work up revealed
hypertrophy of the prostate, benign. He is admitted for cystoscopy and
transurethral resection of the prostate.
PROCEDURE:
With the patient placed in lithotomy position and after preparing the patient
with
betadine in the usual fashion, cystourethroscopy was performed revealing
obstruction of the bladder outlet and stricture of the urethra. The stricture was
dilated, meatotomy performed with #20 resectoscope sheath. Approximately
10
grams of the lobe of the prostate was resected. Foley catheter was inserted,
Hemostasis was obtained. Estimate blood loss, 100 cc. The patient was sent
to
the recovery room in satisfactory condition.
Main Code
• TURP
• 52601 APC 163 $1479.60
• Other procedures?
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Cystourethroscopy
Dilation of structure
Meatotomy
Insertion of Foley Catheter
Other Urology Issues
• 53440 type of operation (sling)
– Different from codes showing treatment by
artificial sphincter
– Highly weighted APC 385 (weight is 97) $6447.34
• xxx42 for removal/revision of sling, male
– Usually for infection or not working correctly
– APC 168 $2022.07
Dilation of urethral stricture
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53600 initial $190.50
01 Subsequent $68.93
05 Male with sound $1241.45
60 Female, initial $1312,12
Male Genital
• Circumcision
– Depends on device used ($1508.63)
• Note under 54640 With or without
hernia
– Code separately inguinal hernia
• Most of prostate surgeries are inpatient
only
Female Genital
• Colposcopy codes
– 56820, x6821 for vulva
• Used for dx symptoms of papilloma virus (HPV),
cancer of vulva
• with biopsy
– x7420, 21 entire vagina including cervix
– x7452-61 New and revised to show colposcopy
of cervix with additional procedures
• Difference between last two sets of codes: focus on
vagina, use x7420, 21
• Focus on cervix, use x7452 family as appropriate
Biopsy vs. conization
• x7460 doesn’t remove portion of
endocervix so is not conizationremoving lesion on exocervix
• x7461 is conization-removal of coneshaped material from endocervix
Uterus Procedures
• Abdominal procedures are inpatient
• 58145 vaginal myomectomies
– 1-4 fibroid tumors, 250 g or less
• Laparoscopic Myomectomies
– 1-4 lesions
– 5 or more/weight 250 g or more
• Most hysterectomies are inpatient only
– x8550 lap. Assisted vaginal
• Miscarriage/missed abortion (fetus intact but
deceased)
– x9812-21
Neurology
• Most are C Inpt procedures
• Neurostimulators Revision of electrodes
– 61880 Revision/removal intracranial electrodes
• T APC 687, $1297.25
– x1885 Insertion pulse generator with array
connections
• Single $12,545.
• Two or more arrays $18,313
– xxx88 Revision/removal pulse gen $1951
Treatment Skull Fracture
• Only one code for outpatient
• 62000 Elevation depressed skull fx,
simple, extradural
Lysis of adhesions
• Use catheter to inject substances such
as saline, steroid, anesthetics to
targeted areas
• Includes insertion/removal catheter to
admin neurolytic to destroy lesions on
spine
• 62263 use once for entire treatment
• X2264 tx on one day only
Other Spinal Procedures
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Aspiration for dx purposes
Aspiration of cyst
Needle bx
LP/Spinal Puncture APC 206, $241
Injection neurolytic agents
Pain Management
• Most of Epidurals coded from 6231062319
– Single vs. catheter placement
– Cervical/thoracic/lumbar/sacral
– Dx or Therapeutic agents
• Anesthetic, antispasmodic, opiod, steroid, etc.)
Laminotomy/Decompression
Procedures
• Mostly for Herniated Discs
• Watch for secondary procedures as these can
impact code
• Coded by procedure and part of spine
• Interspace is disc
• Vertebral segment is bone
• Op reports usually refer to space between bones L-4,
L-5 is one interspace, not two bones
• Most are unilateral with instructions for modifier 50 if
bilateral
• Most are APC 208 $3210
Destruction by Neurolytic Agent,
Nerves
• Start at x4600
• Chemodenervation-doesn’t actual
destroy the nerve, just keeps nerves
from talking to each other
• Botox
• Lasts about 6 months normally
• Has to be repeated when wears off
Plantar Digital Nerve
• Used tx Morton’s neuroma
– Lower extremity only
• 64455
– injection of anesthetic agent/steroid plantar common digital
nerves
• Coded once per session
• Destruction by Neurolytic Agent
– 64632
– Note to indicate that procedures include injection of
agents such as corticosteroids
• Do not use these two codes together
Eye Procedures – 6xxxx
• foreign body removal 65205-65
– must know the site and technique of removal
– slit lamp or magnet used in removal process
– Most APC 698 $61.69 (ED/Clinic)
– X5235 fb intraocular, removed from anterior
chamber of eye APC 0233 $1105.89
Cataract extractions
• Intracapsular
– lens is removed leaving the anterior and posterior
capsule
• extracapsular extraction
– posterior capsule remains in place
• removal includes the lateral canthotomy,
iridectomy, iridotomy, anterior capsulotomy,
posterior capsulotomy, use of viscoelastic
agents, and subconjuctival injections
• If vitrectomy is performed, an additional code
should be used
Complex vs. simple
• Complex usually requires devices
such as iris expansion, suture
support, capsulorrhexis or performed
on pediatric pt whose eye is still
developing
• All APC 246 $1604
Prophylaxis 67141
• Treatment during one or more sessions,
may be different encounters
• Report once during “defined treatment
period”
– Tx retinopathy, extensive/progressive,
one/more sessions
– Cryotherapy, diathermy $1474
– Photocoagulation $347
• Use -50 for bilateral procedure
Blepharoptosis
• Repairs 67901-67908
• Dependent on type of procedure and
approach
– Internal/external
– Levator resection or advancement
Reconstruction
• More than skin
• X7930 suture of eyelid wound
– Partial thickness vs full thickness
Ear
• Removal impacted ear wax x9210
$40.69
• Most common PE Tubes
– Tympanostomy 69433-36
• Local vs. general anesthesia
Insertion Cochlear Device
• To restore hearing/partial hearing
• APC 259 Wt. 401 $26,497.98
Operating Microscope
• Do not use with modifier 51
• Use as add on code
• Don’t use for visualization with magnifying
loupes/corrected vision
• Don’t use when it is integral to procedure
– Added to list of codes where it is included
Training/Inservice to
Physicians
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Documentation of exact procedures
Focus of procedures
Use of additional scopes
Brand names
Watch terminology
Many inpatient procedures
Remember that coding rules/Medicare
rules/physician language does not
always match up. You are the expert in
CPT coding!
We can’t do it without good
documentation and Team Effort!
How To Keep Up
• www.cms.gov
• Memorandums
• Your MAC/FI Web Site
• www.ahima.org
• Resources
– CPT Assistant
– 2009 CPT Book
– 2009 CPT: An Insider’s Guide
– Coder’s Desk Reference for Procedures