CPT codes for urologists and genitourinary procedures didn’t see a whole lot of action in the 2019 coding updates, but you still need to make sure you’re not ignoring the few crucial coding changes that will impact your practice.
And among the new, revised, and deleted CPT codes are added Evaluation and Management (E/M) codes. Understanding how to code for E/M services is particularly essential for urologists, because there are so many different scenarios—from consultations and incident-to visits, to critical care and observation services, according to coding guru Dr. Michael Ferragamo in his 2019 Coding Updates Virtual Boot Camp for Urology.
3 Added Codes & 1 Deletion
Overall, the Centers for Medicare & Medicaid Services (CMS) made 335 code changes to the 2019 CPT code set, according to The Coding Network. These code updates are effective for services performed on or after January 1, 2019.
New: CMS added the following urology/genitourinary CPT codes for 2019:
- 50436 — Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed
- 50437 — … when performed; including new access into the renal collecting system
- 53854 — Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy
And CMS deleted one urology-specific CPT code:
- 50395 — Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous
New E/M Codes: Payment for Digital Medicine
Although only a handful of CPT code changes affect urology-specific procedures, the 2019 update includes several added, deleted, and revised E/M codes that are sure to impact your practice.
The new E/M codes focus on remote patient monitoring. The idea is to better reflect how healthcare professionals use technology to connect with patients at home to gather care management and coordination data, according to the American Medical Association (AMA) Wire. The added E/M codes include:
- 99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
- 99452 — Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
- 99453 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
- 99454 — … device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
- 99457 — Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
- 99491 — Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.
Stay Alert: PFS Will Introduce More Changes
The proposed 2019 Medicare Physician Fee Schedule (PFS) may yield even more changes for urology practices. According to the American Urological Association (AUA), some of the major proposed changes include:
- Revamping E/M visit coding and documentation;
- Revising reimbursement guidelines for telehealth and “communication-based technology services;”
- Changing the valuation of certain urology codes;
- Updating guidance for Medicare Part B drugs; and
- Revising the Quality Payment Program.
Bonus: The proposed fee schedule changes should yield a four-percent increase in allowable charges for urology, the AUA reported. The proposed rule would also change the work Relative Value Units (RVUs) for several urology codes, including ES005 (endoscope disinfector), 52000, 53580, 53582, and 53854.
Bottom line: Make sure you’re keeping up with all the CPT coding changes for 2019, so you don’t lose out on deserved reimbursement. You may soon find yourself billing for urology visits that you haven’t billed for in the past, stresses Michael Ferragamo in his comprehensive Virtual Boot Camp sessions focused on CPT codes for urologists.
