Understanding the Coding Structure of Urology Billing Services

In 2020, several changes in ICD-10 and CPT codes were implemented as per the updated rules and regulations. As a urology medical practitioner, you need to understand such updates and implement them in your urology medical billing guidelines for timely reimbursement and accurate billing.

New codes of ICD-10

The highest known level of specificity must always be assigned a diagnosis code. Effective since October 1, 2019, the changes in the ICD-10 codes for primary urology issues are:

• Changes in code descriptions
• Additional codes and
• A new note with instructions without any description changes

CPT Code Changes

New series of category III codes

CPT codes have category I and Category III (also known as T codes) codes. The category I codes are standard codes used for reporting the services. The category III codes are used for tracking the utilization of the services, procedures, and emerging technologies.

In 2020, a new series of category III codes were introduced that came into effect from January 1, 2020. The codes 0587T-0590T are used to insert, replace, and remove an integrated single device neuro-stimulation system. The analysis and the testing are also included in the codes. The new codes can account for the differences necessary for the performance of these services:

0582T– transurethral ablation of malignant prostate tissues with high energy water vapor thermotherapy. It also includes intraoperative imaging and needle guidance.

0548T– transperineal periurethral balloon continence device. It also includes bilateral placement and cystoscopy.

0549T– transperineal periurethral balloon continence device. It also includes unilateral placement and cystoscopy.

0550T– Transperineal periurethral balloon continence device; removal of each balloon.

0551T– Transperineal periurethral balloon continence device, along with the adjustment of the balloons and the fluid volume.

0587T– percutaneous implantation or the replacement of the integrated single device neuro-stimulation system. It includes the electrode array and the pulse generator or the receiver. It also consists of the analysis and the programming, imaging guidance along with posterior tibial nerves.

0588T– removal or the revision of the integrated single device neuro-stimulation system includes the electrode array and the pulse generator or the receiver. It also includes the analysis, programming, and imaging guidance of the posterior tibial nerves.

0589T– electronic analysis of the implanted integrated neuro-stimulation system with simple programming. It also includes the contact groups, pulse width, amplitude, frequency, burst, on/off cycling, dose lockout, selectable patient parameters, detection algorithms, responsive neuro-stimulations, closed-loop parameters, passive parameters, performed by physicians or qualified healthcare professionals, 4 or more parameters with posterior tibial nerve.

Points to be noted

• As per the recent Urology Times article, category III codes are nothing but unique subsets of the CPT codes. Urologists must understand their values and know how to use them for appropriate reimbursements.
• The code descriptors include imaging, analysis, and programming as a part of the placement procedures. Hence these services are not reported separately.
• To report the electronic analysis with simple and complex programming, there are separate codes. These codes must be used at the time of independent placement or revision services.
• There is guidance available for the new codes’ intended use, including the category III section parentheticals and the exclusionary parentheticals.

New and deleted codes for biofeedback training

New– time based new codes have now been created to allow the doctors to describe the service provided. It helps in the proper reimbursement for the time and effort spent in face time with the patient. The two time-based biofeedback codes are:

• 90912– It includes biofeedback training along with anorectal or urethral sphincter, perineal muscles, including the manometry. It also contains 15 minutes of face time with the doctors or other healthcare professionals.
• 90913– Each extra 15 minutes of face time with the doctor or other healthcare professional for the patients. This is a different code along with the primary procedure codes.

Points to be noted:

• For codes 90912 and 90913, EMG and manometry are included if performed.
• Code 90913 is also an add-on code for describing each extra 15 minutes of face time with the doctor. It cannot be billed alone but can be used in conjunction with the code 90912.

Deleted– The below codes are deleted:

90911– Biofeedback training along with perineal muscles and the urethral sphincter, anorectal including EMG and or manometry.

Revisions

The 2020 CPT code changes for urology medical billing include revisions under the urinary or the bladder systems:

• The parenthetical note in code 51715 has been deleted. It mentioned endoscopic injection of the implant material into the urethra or the bladder.
• The Orchiopexy code 54640 has been revised:

1. CPT 54640- Orchiopexy, scrotal or inguinal approach.

Conclusion

You also need to update the templates to load the new codes as a urology practice. You must check the payer rules before rendering the services, especially for urology medical billing of the Category III codes. That’s why the top-most medical billing companies like 24/7 Medical Billing Services stay updated on the ICD-10, and CPT code changes as an expert in urology medical billing services. To report the correct codes, it is wise to partner with such a reliable urology medical billing services provider.

Read More : All You Want To Know About Urology Billing Services