Watch for these urology-related CPT codes this January

Jonathan Rubenstein, MD

Current Procedure Terminology (CPT) codes are continuously being updated. New and updated Category I and III codes will become active on January 1, 2022. In addition, some other Category III codes may be released on July 1 of the calendar year, prior to the release of the new CPT code book. For a discussion about how to report Category III codes, please see our previous article on this subject.¹ Here are new and updated CPT codes that may be of interest to urologists.

Category I codes: periurethral balloon continence device procedures (53451, 53452, 53453, 53454)

53451: periurethral transperineal adjustable balloon continence device; bilateral insertion, including cystourethroscopy and imaging guidance. (Do not report 53451 in conjunction with 52000, 53452, 53453, 53454, or 76000.)

53452: unilateral insertion, including cystourethroscopy and imaging guidance. (Do not report 53452 in conjunction with 52000, 53451, 53453, 53454, or 76000.)

53453: removal, each balloon. Do not report 53453 in conjunction with 53451, 53452, or 53454.

53454: percutaneous adjustment of balloon(s) fluid volume. (Report only once per patient encounter. Do not report 53454 in conjunction with 53451, 53452, or 53453.)

Mark Painter

Discussion: The new year will bring 4 new Category I CPT codes that describe the insertion, removal, or fluid adjustment of periurethral balloon continence devices. These 4 codes will replace Category III codes 0548T, 0549T, 0550T, and 0551T, which are currently used to report these procedures. The reason for the change was that the maturation of data and use of these procedures met the American Medical Association’s criteria to achieve a Category I status. It is important to be aware of the code change and use the new codes to report these procedures starting January 1. The 4 codes include descriptions of the work of the code along with the exclusions and reporting instructions, which are listed in the associated parentheticals beneath each code.

Category I: Wording change for hypospadias repair codes (54340, 54344, 54348, 54352)

54340: repair of hypospadias complication(s) (eg, fistula, stricture, diverticula); by closure, incision, or excision, simple

54344: requiring mobilization of skin flaps and urethroplasty with flap or patch graft

54348: requiring extensive dissection and urethroplasty with flap, patch, or tubed graft, including urinary diversion, when performed

54352: revision of prior hypospadias repair requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and skin brought in as flaps or grafts. (Do not report 54352 in conjunction with 15275, 15574, 15740, 53235, 53410, 54300, 54336, 54340, 54344, 54348, or 54360.)

Discussion: CPT code 53452 describes a revision of prior hypospadias repair of ultimate complexity that requires work above that of a flap, patch, or graft but also including excision of previously constructed structures. The code is mainly an editorial change because the previously used code had an outdated term that could be interpreted as offensive. The new terminology also more accurately describes the work performed.

Category III Code: Monopolar radiofrequency remodeling of the female bladder neck

0672T: endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence

Discussion: Category III code 0672T describes a technology to treat female stress urinary incontinence with a novel dual-energy procedure, described as endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissue surrounding the female bladder neck and proximal urethra for urinary incontinence. The device itself is not yet approved by the FDA.

Category III Code: Ultrasound-guided focal laser ablation-prostate tissue

0655T:transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with magnetic resonance-fused images or other enhanced ultrasound imaging. (Do not report 0655T in conjunction with 52000, 76376, 76377, 76872, 76940, 76942, or 76998.)

Discussion: This CPT code should be used for reporting transperineal focal laser ablation of malignant prostate tissue. Imaging guidance is included and should not be reported separately.

As you update your systems and charge communication platforms for 2022, it is important to avoid using new CPT codes until they become effective on January 1, 2022. We are expecting the release of the final rule from Medicare with relative value units for the Category I codes in early November. Coverage for new codes may take some time for Medicare and other payers to develop, but all HIPAA-compliant entities are required to adopt the new CPT codes on January 1, 2022. CPT and Medicare coding conventions require reporting the most accurate code available. Private payers may require special reporting of new services if covered and are encouraged to obtain any special instructions in writing, if possible.

ICD-10 coding changes for 2022 became effective on October 1, 2021. Each office is encouraged to review the changes for ICD-10 as soon as possible for any changes relevant to its practice. All ICD-10 changes can be found in the 2022 Addendum file at the following link: https://go.cms.gov/3EYc39S.

A summary of the minor changes to ICD-10 for 2022 considered relevant to urology includes

minor changes in Excludes notes for codes N16 renal tubulointerstitial disorders in diseases classified elsewhere and N39 other disorders of urinary system.

Added codes:

R35.81 Nocturnal polyuria

R35.89 Other polyuria

Z92.85 Personal history of cellular therapy

Z92.850 Personal history of chimeric antigen receptor T-cell therapy

Z92.858 Personal history of other cellular therapy

Z92.859 Personal history of cellular therapy, unspecified

Z92.86 Personal history of gene therapy

Additional Z code changes for patient status relative to food insecurity and homelessness may be relevant to some practices but were not included as urology specific for this article.

Reference

1. Rubenstein J, Painter M. What are Category III codes, and how are they best used for billing? Urology Times®. January 31, 2020. Accessed September 27, 2021. https://bit.ly/3zLtt5y