The world of medical billing can be complex, and urology is no exception. Fortunately, remaining informed about the most recent Current Procedural Terminology (CPT) code updates can assist with guaranteeing your training gets legitimate repayment for administrations delivered. This article investigates some of the critical changes in urology CPT codes for 2024, enabling you to explore the charging scene with certainty.
Updates to Evaluation and Management (E/M) Codes
The E/M section of CPT has minor updates for 2024, focusing on time listing and Shared/Split visit definitions. Office and Outpatient E/M codes will now use a time threshold instead of a time range to align with other E/M codes.
For example, CPT code 99204 will change from a 45-59 minute range to a threshold of 45 minutes or more. Additionally, CPT added a definition for shared/split visits, aiming to influence CMS policy and allow visits from an advanced practice provider and physician to be reported based on either the time spent or the substantive portion of medical decision-making.
New and Updated CPT Codes for Urology ( January 2024)
CPT 64590:
Insertion or replacement of a peripheral, sacral, or gastric neurostimulator pulse generator or receiver requires a pocket and connection between the electrode array and the pulse generator or receiver.
CPT 64595:
Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with a detachable connection to the electrode array.
CPT 99459:
Female pelvic exam (list separately in addition to code for primary procedure).
CPT 52284:
Cystourethroscopy procedure with mechanical urethral dilation and drug-coated balloon catheter for urethral stricture or stenosis in males, including fluoroscopy if required.
CPT 0816T:
Open insertion or replacement of integrated neurostimulation system for bladder dysfunction, including electrode(s) (e.g., array or leadless), pulse generator or receiver, including analysis, programming, and imaging guidance when performed, posterior tibial nerve; subcutaneous.
CPT 0817T:
Open insertion or replacement, subfascial.
CPT 0818T:
Revision or removal, subcutaneous.
CPT 0819T:
Revision or removal, subfascial.
CPT 0587T:
Percutaneous implantation or substitution of incorporated single-gadget neurostimulation framework for bladder brokenness, including anode cluster and beneficiary or heartbeat generator, investigation, programming, and imaging direction when performed, back tibial nerve.
CPT 0588T:
Revision or removal.
Parentheticals teach not to report codes 0816T through 0819T with codes 64555, 64566, 64575, 64590, 64596, 95970, 95971, 95972, 0588T, 0589T, and 0590T.
CPT 0589T:
Electronic analysis with simple programming of an implanted integrated neurostimulation system for bladder dysfunction (e.g., electrode array and receiver), posterior tibial nerve, 1-3 parameters.
CPT 0590T:
Electronic analysis with simple programming, 4 or more parameters.
Codes 0589T and 0590T report programming for either an open or percutaneous device targeting the tibial nerve.
CPT 0786T:
Experience the benefits of inserting or replacing a percutaneous electrode array in the sacral region, combined with an integrated neurostimulator, all performed with the precision of imaging guidance.
CPT 0788T:
Revision or removal.
CPT 0789T:
Electronic analysis with simple programming of an implanted integrated neurostimulation system (e.g., electrode array and receiver), spinal cord or sacral nerve, 1-3 parameters.
CPT 0790T:
Electronic analysis with simple programming, 4 or more parameters.
CPT 0811T:
Remote multiday complex uroflowmetry (e.g., calibrated electronic equipment); setup and patient education on the use of equipment.
CPT 0812T:
Device supply with automated report generation, up to 10 days.
CPT 0864T:
Remember: “Low-intensity shock wave therapy for the corpus cavernosum using low energy.” This list is not comprehensive but highlights commonly used urology codes. Contact us today for more information on how we can help improve your urology practice’s revenues.
Enhancing the Use of Urology CPT Codes
To optimize the use of urology CPT codes, follow these essential steps:
- Seek Prior Authorization: Get earlier approval from the payer before implementing the system.
- Document Thoroughly: Guarantee exact and point-by-point documentation in the clinical record, clearly depicting the technique and legitimizing its clinical need.
- Select Appropriate Unlisted Code: Pick the unlisted code from the pertinent physical CPT list. For instance, CPT 51999 can be utilized for an unlisted bladder method.
- Reference Comparable Procedures: Utilize the CPT code of a comparative strategy as a source of perspective while setting the charge for the unlisted code, adapting to the overall intricacy of the performed procedure.
- Provide Detailed Descriptions: Include a procedure description in item 19 on the CMS-1500 claim form.
- Follow Up with Payers: Proactively follow up with payers, as they may require additional information, or you might need to appeal an initial claim denial.
While billing for unlisted procedure services may require extra effort, adhering to payer requirements and providing comprehensive procedure details can expedite claim processing and payment turnaround times.
Conclusion:
By remaining informed about new urology codes, you can guarantee your training gets exact reimbursement for the essential administrations you give. Consider collaborating with a clinical charging organization, such as RCM Matter, which has expertise in urology coding, to explore the intricacies and streamline your billing processes.
