From vaginal prolapse procedures to corrective urinary incontinence surgeries, your urology and gynecology coding may frequently overlap.
And if you want to avoid denials and reap the reimbursement you deserve, you must have a solid understanding of the proper uro-gynecological coding mechanisms and clinical scenarios, says urology coding expert Dr. Michael Ferragamo in his audio conference, “2019 Uro-Gynecological Coding Update.”
Identify Newer Uro-Gynecological CPT® Codes
For 2018, the Centers for Medicare & Medicaid Services (CMS) revised the descriptions for three vaginal repair CPT® codes to add the phrase “including cystourethroscopy, when performed,” according to the American College of Obstetricians and Gynecologists (ACOG).
CMS also added parentheticals to each coding stating that you cannot report cystourethroscopy code 52000 with any of these codes:
- 57240 — Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed
- 57260 — Combined anterposterior colporrhaphy; including cystourethroscopy, when performed
- 57265 — Combined anterposterior colporrhaphy; with enterocele repair, including cystourethroscopy, when performed
Beware: You should not bill 52000 separately from 57240, 57260, and 57265, with or without appending Modifier -59, warns the organization, Advancing Female Pelvic Medicine and Reconstructive Surgery (AUGS). CPT® code 52000 includes the phrase “separate procedure” in its descriptor, which has led the code to become subject to many code-pair edits.
Also: In a presentation , Ronald Kaufman, Jr., Associate Professor of Urology at Albany Medical College, highlights another new CPT® code for 2018:
- 38573 — Laparoscopic total pelvic lymphadenectomy with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed
Watch out: Don’t report 38573 with any other lymph node dissection codes. Nor should you report this code in conjunction with: 38562, 38564, 38570-38572, 38589, 38770, 38780, 49255, 49320, 49326, 58541-58544, 58548, 58550, and 58552-58554.
Other laparoscopic lymph node dissection codes include the following:
- 38570 — Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
- 38571 — … with bilateral total pelvic lymphadenectomy
- 38572 — … with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple
Know the Correct Way to Report Urodynamic Testing
What’s more: Urology coders may also struggle with proper coding for urodynamic procedures. When reporting these, use the following CPT® codes:
- 51726 — Complex cystometrogram (i.e., calibrated electronic equipment)
- 51727 — … with urethral pressure profile studies (i.e., urethral closure pressure profile), any technique
- 51728 — … with voiding pressure studies (i.e., bladder voiding pressure), any technique
- 51729 — … with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique
- 51797 — Voiding pressure studies, intra-abdominal (i.e., rectal, gastric, intraperitoneal)
Note: CPT® code 51797 is an add-on code that you may use with 51728 and 51729. Make sure you list 51797 separately in addition to the primary procedure code.
Also, for full urodynamic testing, you would report the following four CPT® codes:
- 51741 for complex uroflowmetry;
- 51729 for complex cystometrogram, including measuring urethral pressure and bladder voiding/flow pressure;
- 51784 or 51785 for the electromyography (EMG); and
- 51797 for the abdominal pressure, whether measured rectally or vaginally.
Don’t Ignore Hysterectomy & Cystourethroscopy Codes
Pay attention: CMS also added a new code for laparoscopic total hysterectomy for resection on malignancy with omentectomy, ACOG noted. The new CPT® code is:
- 58575 — Laparoscopy, surgical, with total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed
Mistake: You should not report code 58575 in conjunction with the following codes: 49255, 49320, 49321, 58570, 58571, 58572, 58573, and 58661.
Also, don’t overlook a Category III code that popped up in 2018:
- 0499T — Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed
Be careful: You cannot report 0499T in conjunction with 52281 and 52283. Also keep in mind that this code includes the drug, so you should not report that separately.
Bottom line: Coding accurately for uro-gynecological procedures can be tricky and confusing. Make sure you understand the proper coding of even the toughest scenarios, such as laparoscopic biopsy of ovaries, fallopian tubes, and pelvic masses, stresses Ferragamo in his “2019 Uro-Gynecological Coding Update” audio conference.
