The word’s out: Claims reimbursements are getting tougher for urology coders, and all the looming changes to CPT® and ICD-10-CM codes don’t make things any easier. It’s your job to accurately present and report urology procedures and services. Drill down into your knowledge now and check it for gaps, so you’re ready to tackle all the upcoming challenges!
To navigate ICD-10-CM and CPT® code changes for urology, you’ll need to be up to date on percutaneous nephrolithotomy (PCNL) procedures and ancillary codes, as well as abnormal urinary findings and other situations, says urology coding guru Michael Ferragamo. During his CPT® and ICD-10-CM urology updates webinars as part of ProfEdOnDemand’s 2019 Coding Updates Virtual Boot Camp, Ferragamo outlines the details of and requirements for each urology diagnosis and procedure to shine the light on any areas that may be tripping you up.
N35: Urethral Stricture Codes
CPT® coding changes for urology are on their way and will take effect Jan. 1, 2019; we’ll have more specific details on what’s changing a little later in the year. While you’re waiting, focus on the ICD-10-CM codes—which you’ll have to start using on Oct. 1, 2018.
One key subset of adjusted ICD-10-CM codes deal with urethral strictures, or when the urethra narrows after injury, infection, or urethritis. Code N35.9, Urethral stricture, unspecified, is deleted. The new codes are:
Other urethral stricture
- 811, Male, meatal
- 812, Other urethral bulbous stricture, male
- 816, Male, overlapping sites
- 819, Male, unspecified site
- 82, Female
- 813, Other membranous urethral stricture, male
- 814, Other anterior urethral stricture, male, anterior
Unspecified strictures
- 911, Male, meatal
- 912, Unspecified bulbous urethral stricture, male
- 913, Unspecified membranous urethral stricture, male
- 914, Unspecified anterior urethral stricture, male
- 916, Male, overlapping sites
- 919, Male, unspecified site
- 92, Female
Other v. Unspecified: Differentiating between “other” and “unspecified” codes can be tricky. Per the 2019 Coding Guidelines, you would use “other” codes when the medical record indicates a procedure or situation for which no code exists; you should use “unspecified” when there is insufficient evidence in the medical record to indicate which exact procedure or situation occurred.
Abnormal Urinary Findings Codes
Other coding changes for urology include the subset of abnormal urinary findings codes. Gone is R82.99, Other abnormal findings in urine, and these 5 codes (all dealing with kidney stone formation) have been added:
- 991, Hypocitraturia (lower than normal levels of urine citrate)
- 992, Hyperoxaluria (an overproduction of oxalate)
- 993, Hyperuricoscuria (when too much uric acid is present in urine)
- 994, Hypercalciuria (excessive urine calcium excretion)
- 998, Other abnormal findings in urine
CPT®: Look Out for New PCNL Codes
As mentioned, PCNL coding changes have been hinted at, but to date nothing specific has been announced. That being said, make sure you have a solid understanding of what PCNL is, and which codes (50080-81, 50395, 50430-33, 50561, 52005, 52332, and 74420) are associated with it.
PCNL is a procedure used to remove irregularly shaped or large kidney stones from patients when other common treatments have not worked or were not an option for this particular patient.
The two codes dealing directly with PCNL are 50080 and 50081. Ancillary codes address catheter placement and other related procedures. PCNL coding changes over the years have primarily been additions and deletions, rather than revisions—so expect this trend to continue, while at the same time remaining prepared for anything to happen.
Quick Note: In addition to checking for updates to the CPT® codes themselves, remember to keep track of changes in payer policies. Each payer policy will vary, and some may make adjustments for 2019 while others may not. Consult relevant manuals for appropriate coding options whenever possible.
Get Live Guidance on 53+ Upcoming Changes
Claims reimbursements are going to get tougher for 2019. Here, we’ve given you just a sampling of the 2019 ICD-10-CM and CPT® changes, but there are 53 adjusted ICD-10 codes coming and an unknown amount of CPT® codes to be on the lookout for. Changes to both code sets will challenge you when it comes to accurately presenting and reporting urology procedures and services, says Ferragamo. Take advantage of the webinars in this year’s 2019 Coding Updates Virtual Boot Camp to get any questions you have answered live and take the guesswork out of what’s coming next!
