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Focused CPT Management Series: Urology/Male/Female/Neurology and Sense Organs Karen Scott, MEd, RHIA, CCS-P, CPC Karen Scott Seminars and Consulting Memphis,

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Presentation on theme: "Focused CPT Management Series: Urology/Male/Female/Neurology and Sense Organs Karen Scott, MEd, RHIA, CCS-P, CPC Karen Scott Seminars and Consulting Memphis,"— Presentation transcript:

1 Focused CPT Management Series: Urology/Male/Female/Neurology and Sense Organs Karen Scott, MEd, RHIA, CCS-P, CPC Karen Scott Seminars and Consulting Memphis, TN All CPT codes and descriptions are copyright protected by the AMA

2 Agenda Discussion of the common Coding Problem Areas Factors that impact APC Payment Training issues for physicians and other documenting personnel

3 Urinary System Biggest problem encountered is anatomy Two kidneys lead to two tubes called ureters Which lead to the bladder One tube leading out of the bladder to the outside of the body called urethra Very easy to pick wrong code based on similar wording Ureteroscopy/Urethroscopy

4 Inpatient vs. Outpatient procedures Lots of inpatient procedures right in the middle of the codes for outpatient Such as x0075 Removal of large staghorn calculus-Inpatient

5 A few Outpatient procedures X0020, 21 Abscess drainage from kidney area open (APC 162 $ ) vs. percutaneous (APC 0037, $892.96) x0080, 81 Percutaneous kidney stone removal- APC 0429, $ ) –Coded by size only –Lots of procedures included in base code

6 Stents Indwelling/Internally Dwelling vs. Externally Accessible Put in for usually week or more to keep ureter open after surgery or to help stone fragments pass easier –“Double J Stent”-very common –Codes: Change out vs. just removal, insertion under other sections –Coded by approach –Unilateral –Radiology portion of codes included

7 Laparoscopic Vs. Open procedures Most of the open procedures on the inpt only list Kidney X0541 Destruction kidney cysts 130 $ x0542 destruction of renal lesions 174 $7, x0543-removal of lesion; partial removal of kidney 131 $3, X0544 pyeloplasty 130 $2, X0545 Radical nephrectomy Inpt. procedure

8 Kidney Endoscopic Procedures APC Placement depends on what surgical procedures are done 50551, 55, 62, 70, 72, 74 APC 160, $ , 57, 61 APC 162 $ , 80 APC 161 $ APC 163, $

9 Bladder Drainage Aspiration of bladder by needle –Through skin to remove urine from bladder –APC 164 $ Aspiration of bladder by trochar/catheter –APC 126 $ Including insertion of catheter –Catheter is placed through opening –APC 165 $ –Can code radiology separately

10 Bladder Insertion of non-indwelling catheters –51701-for left over urine X 340 $42.69 –51702-temporary catheter, such as Foley –51703-Complicated insertion of temp. catheter T126 $68.93

11 Urodynamics Measurement of urine flow, residuals Simple vs. complex –Depends on type of equipment used

12 Cystourethroscopy Many times are inclusive in other procedures Different codes dependent on what is removed –Stone, lesion, tumor, size (small, medium, large) watch wording- included “multiple obstructing” clots

13 Ureter and Pelvis Indwelling stent coded to APC 162 $ –Gibbons/Double-J 52354, shows specific location of lesion/tumor APC 162

14 OP Report Preoperative Diagnosis: BPH Postoperative Diagnosis: Same Procedure: TURP, Cystoscopy 74 year old white male presenting with unable to void, work up revealed hypertrophy of the prostate, benign. He is admitted for cystoscopy and transurethral resection of the prostate. PROCEDURE: With the patient placed in lithotomy position and after preparing the patient with betadine in the usual fashion, cystourethroscopy was performed revealing obstruction of the bladder outlet and stricture of the urethra. The stricture was dilated, meatotomy performed with #20 resectoscope sheath. Approximately 10 grams of the lobe of the prostate was resected. Foley catheter was inserted, Hemostasis was obtained. Estimate blood loss, 100 cc. The patient was sent to the recovery room in satisfactory condition.

15 Main Code TURP APC 163 $ Other procedures? –Cystourethroscopy –Dilation of structure –Meatotomy –Insertion of Foley Catheter

16 Other Urology Issues type of operation (sling) –Different from codes showing treatment by artificial sphincter –Highly weighted APC 385 (weight is 97) $ xxx42 for removal/revision of sling, male –Usually for infection or not working correctly –APC 168 $

17 Dilation of urethral stricture initial $ Subsequent $ Male with sound $ Female, initial $1312,12

18 Male Genital Circumcision –Depends on device used ($ ) Note under With or without hernia –Code separately inguinal hernia Most of prostate surgeries are inpatient only

19 Female Genital Colposcopy codes –56820, x6821 for vulva Used for dx symptoms of papilloma virus (HPV), cancer of vulva with biopsy –x7420, 21 entire vagina including cervix –x New and revised to show colposcopy of cervix with additional procedures Difference between last two sets of codes: focus on vagina, use x7420, 21 Focus on cervix, use x7452 family as appropriate

20 Biopsy vs. conization x7460 doesn’t remove portion of endocervix so is not conization- removing lesion on exocervix x7461 is conization-removal of cone- shaped material from endocervix

21 Uterus Procedures Abdominal procedures are inpatient vaginal myomectomies –1-4 fibroid tumors, 250 g or less Laparoscopic Myomectomies –1-4 lesions –5 or more/weight 250 g or more Most hysterectomies are inpatient only –x8550 lap. Assisted vaginal Miscarriage/missed abortion (fetus intact but deceased) –x

22 Neurology Most are C Inpt procedures Neurostimulators Revision of electrodes –61880 Revision/removal intracranial electrodes T APC 687, $ –x1885 Insertion pulse generator with array connections Single $12,545. Two or more arrays $18,313 –xxx88 Revision/removal pulse gen $1951

23 Treatment Skull Fracture Only one code for outpatient Elevation depressed skull fx, simple, extradural

24 Lysis of adhesions Use catheter to inject substances such as saline, steroid, anesthetics to targeted areas Includes insertion/removal catheter to admin neurolytic to destroy lesions on spine use once for entire treatment X2264 tx on one day only

25 Other Spinal Procedures Aspiration for dx purposes Aspiration of cyst Needle bx LP/Spinal Puncture APC 206, $241 Injection neurolytic agents

26 Pain Management Most of Epidurals coded from –Single vs. catheter placement –Cervical/thoracic/lumbar/sacral –Dx or Therapeutic agents Anesthetic, antispasmodic, opiod, steroid, etc.)

27 Laminotomy/Decompression Procedures Mostly for Herniated Discs Watch for secondary procedures as these can impact code Coded by procedure and part of spine Interspace is disc Vertebral segment is bone Op reports usually refer to space between bones L-4, L-5 is one interspace, not two bones Most are unilateral with instructions for modifier 50 if bilateral Most are APC 208 $3210

28 Destruction by Neurolytic Agent, Nerves Start at x4600 Chemodenervation-doesn’t actual destroy the nerve, just keeps nerves from talking to each other Botox Lasts about 6 months normally Has to be repeated when wears off

29 Plantar Digital Nerve Used tx Morton’s neuroma –Lower extremity only –injection of anesthetic agent/steroid plantar common digital nerves Coded once per session Destruction by Neurolytic Agent –64632 –Note to indicate that procedures include injection of agents such as corticosteroids Do not use these two codes together

30 Eye Procedures – 6xxxx foreign body removal –must know the site and technique of removal –slit lamp or magnet used in removal process –Most APC 698 $61.69 (ED/Clinic) –X5235 fb intraocular, removed from anterior chamber of eye APC 0233 $

31 Cataract extractions Intracapsular –lens is removed leaving the anterior and posterior capsule extracapsular extraction – posterior capsule remains in place removal includes the lateral canthotomy, iridectomy, iridotomy, anterior capsulotomy, posterior capsulotomy, use of viscoelastic agents, and subconjuctival injections If vitrectomy is performed, an additional code should be used

32 Complex vs. simple Complex usually requires devices such as iris expansion, suture support, capsulorrhexis or performed on pediatric pt whose eye is still developing All APC 246 $1604

33 Prophylaxis Treatment during one or more sessions, may be different encounters Report once during “defined treatment period” –Tx retinopathy, extensive/progressive, one/more sessions –Cryotherapy, diathermy $1474 –Photocoagulation $347 Use -50 for bilateral procedure

34 Blepharoptosis Repairs Dependent on type of procedure and approach –Internal/external –Levator resection or advancement

35 Reconstruction More than skin X7930 suture of eyelid wound –Partial thickness vs full thickness

36 Ear Removal impacted ear wax x9210 $40.69 Most common PE Tubes –Tympanostomy Local vs. general anesthesia

37 Insertion Cochlear Device To restore hearing/partial hearing APC 259 Wt. 401 $26,497.98

38 Operating Microscope Do not use with modifier 51 Use as add on code Don’t use for visualization with magnifying loupes/corrected vision Don’t use when it is integral to procedure –Added to list of codes where it is included

39 Training/Inservice to Physicians Documentation of exact procedures Focus of procedures Use of additional scopes Brand names Watch terminology Many inpatient procedures Remember that coding rules/Medicare rules/physician language does not always match up. You are the expert in CPT coding! We can’t do it without good documentation and Team Effort!

40 How To Keep Up Memorandums Your MAC/FI Web Site Resources –CPT Assistant –2009 CPT Book –2009 CPT: An Insider ’ s Guide –Coder ’ s Desk Reference for Procedures Ingenix


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