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Coding Urology (Male)ProceduresAudio Seminar/WebinarNovember 29, 2007Practical Tools for Seminar Learning Copyright 2007 American Health Information Management Association. All rights reserved.
DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.CPT five digit codes, nomenclature, and other data are copyright 2007 AmericanMedical Association. All Rights Reserved. No fee schedules, basic units, relativevalues or related listings are included in CPT. The AMA assumes no liability for thedata contained herein.As a provider of continuing education, the American Health InformationManagement Association (AHIMA) must assure balance, independence, objectivityand scientific rigor in all of its endeavors. AHIMA is solely responsible for control ofprogram objectives and content and the selection of presenters. All speakers andplanning committee members are expected to disclose to the audience: (1) anysignificant financial interest or other relationships with the manufacturer(s) orprovider(s) of any commercial product(s) or services(s) discussed in an educationalpresentation; (2) any significant financial interest or other relationship with anycompanies providing commercial support for the activity; and (3) if thepresentation will include discussion of investigational or unlabeled uses of aproduct. The intent of this requirement is not to prevent a speaker withcommercial affiliations from presenting, but rather to provide the participants withinformation from which they may make their own judgments.AHIMA 2007 Audio Seminar Seriesi
FacultyJean Jurek, MS, RHIA, CPCMs. Jurek has 25 years of ICD-9-CM and CPT coding experience in a variety ofhealthcare settings. She is currently a full-time associate professor for the HITprogram at Erie Community College and President of Jean Jurek Associates Inc.,a medical coding and consulting company.Jerome Ndayishimiye, MS, RHIA, CICMr. Ndayishimiye is quality coding coordinator at Kaleida Health in Buffalo, NY.Mr. Ndayishimiye conducts regular coding audits and education to ensurecontinuous coding quality regulatory compliance, and proper reimbursement.Previously, he consulted on hospital outpatient coding and reimbursement, andis currently serving as finance director of the New York HIMA.AHIMA 2007 Audio Seminar Seriesii
Table of ContentsDisclaimer . iFaculty .iiObjectives . 1Anatomy and Physiology . 1Kidney. 2Male Urinary Tract. 2Common Signs and Symptoms of Urinary Disorders . 3General Diagnostic Methods . 4Urinary System General Coding . 5Case Study A (Outpatient). 5Polling Question #1 . 7Modifiers . 7Benign Prostatic Hyperplasia (BPH). 9ICD-9-CM Procedures .12Sequencing Issues.13Polling Question #2 .14Urinary Incontinence .15Urethral Stricture .17Procedures .18Urolithiasis.19Procedures .22Dysfunction of the Bladder.23Polling Question #3 .24MS-DRGs – Male Urinary System .24Other Important Topics .26Case Study B (Outpatient) .28Case Study C (Outpatient) .29Case Study D (Inpatient) .29Case Study E (Inpatient).30Resource/Reference List .30Audience QuestionsAppendix.34AHIMA 2007 Audio Seminar Series
Coding Urology (Male) ProceduresNotes/Comments/QuestionsObjectives Demonstrate anatomy and physiology ofthe male urinary systemReview common diseases of the maleurinary system and treatment options Overview of corresponding CPT codes Review of applicable ICD-9-CM diagnosisand procedure Discuss CPT and ICD-9-CM and codingguidelinesApply coding guidelines using case studiesand examples1Anatomy and Physiology2AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved1
Coding Urology (Male) ProceduresNotes/Comments/QuestionsAnatomy and Physiology – Kidney Filter blood200 quartsofblood/dayUrine 2 quartsof wasteRelease hormones Erythropoietin or EPOReninCalcitriol3Male Urinary Tract4AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2
Coding Urology (Male) ProceduresNotes/Comments/QuestionsCommon Signs andSymptoms of Urinary Disorders Nocturia (788.43)Incomplete bladderemptying (788.21)Straining (788.65)Frequency (788.41)Hesitancy (788.64)Incontinence(788.30-788.39) Obstruction(599.69)Retention (788.20)Urgency (788.63)Weak urinarystream (788.62)Hematuria (599.7)Slow stream(788.62)5Common Diseases/Disorders Benign ProstaticHyperplasiaProstate cancerUrolithiasisBladder tumorsUrinary tactstricturesUrinaryIncontinenceInterstitial cystitis66AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved3
Coding Urology (Male) ProceduresNotes/Comments/QuestionsGeneral Diagnostic Methods-History andphysical exam-Lab testsUrodynamicsRigid cystoscope andsemirigid ureteroscopeIntravenous pyelogram (IVP)7General Diagnostic MethodsTransrectalultrasoundTransrectalultrasound andprostate biopsyCT ScanMagnetic resonance angiogram (MRA)Digital rectal exam (DRE)AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved84
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrinary System General Coding Therapeutic cystourethroscopy always includes diagnosticcystourethroscopy (CPT 52000) Therapeutic cystourethroscopy with uretroscopy and/orpyeloscopy always includes diagnostic cystourethroscopy withuretroscopy and/or pyeloscopy (CPT 52351) Do not report 52351 in addition to 52344-52346, 52352-52355Diagnostic or therapeutic cystourethroscopy with uretroscopyand/or pyeloscopy includes insertion or removal a temporaryureteral catheter. Do not report 52000 in addition to 52320-52343Do not report 52005 in addition to 52320-52355Do not report 52351 in addition to 52344-52346, 52352-52355 OCE edit 209Case Study – A (Outpatient)Clinical ScenarioA patient with RT ureterstricture was admitted fortreatment. As plannedcystourethroscopy with dilationof the RT ureter stricture wasdone; but due to patientcomplaints of the pain in the LTflank, diagnosticcystourethroscopy withuretroscopy of LT ureter wascarried out. What CPT codes should bereported? A. 52341 B. 52341 and 52351-59Considerations CPT coding instructions say not touse 52351 in addition to 5234152351 is not an inherently abilateral codeCCI edit (facility andprofessional) indicates that52351 is always part of 52341Trigger of OCE 20-Line itemrejectionAMA’s advice (CPT Assistant,Special 2006 Page 5). Both 52341 and 52351 should bereportedCoding Clinic for HCPCS, 3Q, 200410AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved5
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrinary System General Coding Urodynamics Cystometrogram– Simple vs. complex Uroflowmetry– Simple vs. complex Other Physician billing Reporting of cystourethroscopy procedures Diagnostic and therapeutic approach11Urinary System General Coding Surgical laparoscopy always includesdiagnostic laparoscopy. Infusion and injection procedures ( e.g.36000,36140, 90760-90776) are generallyregarded as part of the surgical procedures(CCI Manual). CPT 51701-51703 or 51700 are not separatelyreported when performed as part of otherprocedures (e.g. for postoperative drainage) Confirmatory endoscopy does not represent adiagnostic or surgical endoscopy Do not report insertion and removal oftemporary ureteral catheter (CPT 52005) inaddition to 52320-52355.AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved126
Coding Urology (Male) ProceduresNotes/Comments/QuestionsPolling Question #1A patient with post void dribbling underwent a leakpoint pressure test along with an examination of thebladder through a cystourethroscopy approach. Atthe end of the procedure the bladder was irrigatedand all instruments removed.What is the best choice?*1 600.3, 788.35, 51772, 51701*2 788.35, 51795, 52000, 51700*3 788.35, 51772, 52000*4 None of the above13General Use of Modifiers Modifier 59 CCI edit Modifier 22 Professional Modifier 51 Professional Appendix E for exemption or add-on codes Modifier 58 Confused with modifier 78 Modifier 52 vs. 73 or 7414AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved7
Coding Urology (Male) ProceduresNotes/Comments/QuestionsGeneral Use of ModifiersModifier 50 Codes that read unilateralor bilateral 52290 52300 52301 Modifier LT, RT No modifier 50 Inherent bilateralprocedures Unilateral procedure 52005 52007 52320-52355 Modifier 50 as appropriate520005201052204-5228552305-52318 Reference: CPT Assistant, May2001, Page: 5 Hospital vs. ASC centers Unit “1” vs. “2” No modifier 5015General Use of ModifiersModifier FB, FC eteral stent exchange/removeUreteral stent exchange/removeUreteral stent exchange/removeUreteral stent exchange/removeChange kidney tubeChange of ureter tubeChange of ureter tubeChange of ureter tubeChange of ureter tubeChange of bladder tubeEndoscopic injection/implantEndoscopic injection/implantCorrect bladder functionCorrect bladder functionCorrect bladder functionCorrect bladder functionCorrect bladder functionInsert tandem cuffInsert uro/ves nck sphincterRemove/replace ur 86Device 5Device A DescriptionStent, coated/cov w/o del syStent, non-coat/cov w/o delStent, non-cor, tem w/o delStent, non-cor, tem w/del syCath, drainageCath, drainageCatheter, ureteralStent, non-cor, tem w/o delStent, non-cor, tem w/ delCath, suprapubic/cystoscopicCollagen imp urinary 2.5 mlSynthetic implnt urinary 1mlRep dev, urinary, w/slingConn tiss, human(inc fascia)Conn tiss, non-humanMesh (implantable)Rep dev, urinary, w/o slingPros, urinary sph, impPros, urinary sph, impPros, urinary sph, impAHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights ReservedModifierFB or FCin 2008YESYESYESYESYES168
Coding Urology (Male) ProceduresNotes/Comments/QuestionsBenign Prostatic Hyperplasia (BPH)In 2000, 4.5 millions physician office visits wereprimarily due to BPHDirect cost of about 1.1billion (NIH, 2007)17Benign Prostatic Hyperplasia (BPH) The most prevalent benign neoplasm in American men Some signs and symptoms a hesitant, interrupted, weak stream urgency and leaking or dribbling more frequent urination, especially at night Etiology No definite known reason Age may be a factor Common Diagnostic methods BPH prevalenceestimates byage cohort(NIH, 2007)40-49: 24%50-59: 31%60-79: 36%70-up: 44%Digital Rectal Examination (DRE)Prostate-Specific Antigen (PSA) Blood TestRectal Ultrasound and Prostate BiopsyUrine Flow StudyCystoscopyOther Source: 2007, http://kidney.niddk.nih.gov/statistics/uda/18AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved9
Coding Urology (Male) ProceduresNotes/Comments/QuestionsBPH – ICD-9-CM Perspective The codes for Benign ProstaticHypertrophy and ProstaticHyperplasia (600.0, 600.2 and 600.9)include “with lower urinary tractsymptoms” Determine if symptoms are present Assign a fifth digit of 1 Code those symptoms in addition to thecode for the BPH or hyperplasia19Benign Prostatic Hyperplasia (BPH)TURP (Transurethral resection of the prostate)Instrument with a loop Do not report CPT 52601when laser is used Use visual laser ablation ofthe prostate(VLAP) see CPT codes 5264752648 CPTShort DescriptionSIAPC52601Prostatectomy (TURP)T163For other approachessee CPT codes 5580155845 Modifier 58 as necessary20AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved10
Coding Urology (Male) ProceduresNotes/Comments/QuestionsBenign Prostatic Hyperplasia (BPH)TUNA (transurethral needleablation)TUMT (Transurethralmicrowave thermotherapyCPT538505385253853ICD-9Short crf 75162Description60.96 Transurethral destructionof prostatetissueby microwavethermotherapy60.97 Other transurethral destructionof prostatetissueby other thermotherapy93.35 Other heat therapy99.85 Hyperthermiafor treatment of cancer21Benign Prostatic Hyperplasia(BPH) Greenlight Photoselective Vaporization of the Prostate(PVP) or Greenlight Laser System(GLLS) also known asTULIP ( transurethral ultrasound-guided laser-inducedprostatectomy) Laser used to vaporize the prostate Contact vs. non-contact no longer apply as of January 1, 2006 C9713 - noncontact vaporization is no longer a valid code. For laser vaporization use 52648 Reference: Coding Clinic for HCPCS , 1Q, 2006 For laser coagulation use 52647 Effective January 1, 2008 52649 for Laser enucleation of the prostate with morcellation Do not report vasectomy, meatotomy, dilation, urethrotomy,or resection of the prostate separateAHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2211
Coding Urology (Male) ProceduresNotes/Comments/QuestionsBenign Prostatic Hyperplasia (BPH)Other CPT procedures codesRadical 25586555866Short DescriptionIncision of prostateDilation prostatic urethraProstatectomy (TURP)Prostatectomy, first stageProstatectomy, second stageRemove residual prostateRemove prostate regrowthLaser surgery of prostateLaser surgery of prostateProstatic microwave thermotxProstatic rf thermotxProstatic water thermotherBiopsy of prostateBiopsy of prostateDrainage of prostate abscessDrainage of prostate abscessRemoval of prostateExtensive prostate surgeryExtensive prostate surgeryExtensive prostate surgeryRemoval of prostateRemoval of prostateExtensive prostate surgeryExtensive prostate surgeryExtensive prostate surgerySurgical exposure, prostateExtensive prostate surgeryExtensive prostate surgeryLaparo radical BPH – ICD-9-CM Procedures Transurethral resection of Prostate 60.29 Electrovaporization (TEVAP) -60.29Laser (ablation/vaporization) – (60.21)Microwave Therapy (TUMT) – (60.96)Needle Ablation (TUNA) – (60.97)Radiofrequency Thermotherapy – (60.97)Two stage resection –(60.29, 60.29)Ultrasound guided laser induced (TULIP)-60.21VLAP (visual laser assisted)- (60.21)Water-induced thermotherapy – (60.97)24AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved12
Coding Urology (Male) ProceduresNotes/Comments/QuestionsBPH – ICD-9-CM Procedures Code also additional proceduresperformed: Internal UrethrotomyUrethral MeatotomyUrethral CalibrationUrethral dilationVasectomy25BPH – Sequencing Issues-BPH with symptoms: BPH reported first-Acute renal failure due to BPH and urinaryobstruction:- Sequence acute renal failure first- Coding Clinic, 3Q 2002, page 28-BPH with foci of adenocarcinoma:- UHDDS requires reason for admission (BPH)sequenced first, followed by code for pathologicfindings documented by physician- Coding Clinic 3Q 1992, page 7, and- Coding Clinic 1Q 2004, pages 20-2126AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved13
Coding Urology (Male) ProceduresNotes/Comments/QuestionsPolling Question #2A patient presents with benign prostatichypertrophy (BPH) with urinary frequencyand bladder neck obstruction. He isadmitted for a TUNA procedure and dilationof the bladder neck.*1*2*3*4600.01, 596.0, 788.41, 60.97, 57.92600.00, 596.0, 60.29, 57.92600.00, 788.41, 60.29, 57.92600.01, 596.0, 788.41, 60.9727Urinary Incontinence Stress (788.32) Due to inadequateurethral pressure Urge (788.32) Due to abnormal bladdercontracted Mixed (788.32) Stress urge Functional (307.6) May be due to medications,infection, etc.Up to 30% of patients who have had a radicalprostatectomy experience some degree ofincontinence afterwards (NIH, 2007)AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2814
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrinary Incontinence Artificial sphincter(58.93)To treat urine leakagedue to a weak sphincter CPT codesCPT534445344553446534475344853449Short DescriptionInsert tandem cuffInsert uro/ves nck sphincterRemove uro sphincterRemove/replace ur sphincterRemov/replc ur sphinctr compRepair uro sphincterSISSTSCTAPC0385038601680386016829Urinary IncontinenceSling procedure (59.4)Collagen implant (59.72) A strip of material around theurethra to keep constantpressure on the urethra. Urinary incontinence due intrinsicsphincter deficiency(ISD)Injected in the submucosal tissuesof the urethra and/or the bladderneckCPT codesCPTShort DescriptionSIAPC51992Laparo sling operationT013153440Male sling procedureS038553442Remove/revise male slingT0168CPTShort DescriptionEndoscopic51715 injection/implantSIAPCT016830AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved15
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrinary IncontinenceSacral nerve stimulation (e.g. Interstim Therapy) Test stimulationCPTShort Description6456164581 CPT6458164590SI APCImplant neuroelectrodes(percutaneous)S40S61Implantation phaseImplant neuroelectrodes(incision)Insrt/redo pn/gastr stimulCPT6458564595Implant neuroelectrodes(Incision)Short DescriptionRevision/removal odeRevise/rmv pn/gastr stimulSIAPCT0687T0688SISAPC0692S0692S0663Analysis andprogramming CPT9597195972 95973DescriptionAnalyze neurostim, simpleAnalyze neurostim, complex(first hour)Analyze neurostim, complex( 30 min)31Urinary IncontinenceSacral nerve stimulationICD-9-CM Description596.55Detrusor sphincter dyssynergia596.59Other functional disorder of bladder788.20Retention of urine, unspecified788.21Incomplete bladder emptying788.30Urinary incontinence, unspecified788.31Urge incontinence788.33Mixed incontinence (male) (female)788.34Incontinence without sensory awareness788.41Urinary frequencyICD-9-CM DescriptionImplantation or replacement of peripheralneurostimulator lead(s)Procedure Code: Removal of peripheral04.93neurostimulator lead(s)Insertion or replacement of single array86.94neurostimulator pulse generator04.9286.05Incision with removal of foreign body ordevice from skin and subcutaneousOther treatment options Biofeedback (94.39) Pulsed magneticneuromodulation CPT codesCPTDescriptionSIAPC90911Biofeedback peri/uro/rectalS03210029TMagnetic tx forincontinenceAAHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved3216
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrethral Stricture (598.8) Navicularis, penile urethra,bulbar urethra, membranousurethra, prostatic urethra, orbladder neckCPT Coding Alert For temporary insertion of atemporary prostatic urethralstent Do not use 52282(Cystourethroscopy withinsertion of urethral stent) Use 0084TSome signs and symptoms irritative voiding recurrent urinary tractinfections, urinary retention – Only to be used withoutpermanent stent Reference: AMA CPT Assistant , May2005 page 11Etiology Lichen sclerosisGonocaccal infectionTraumaPostsurgicalOther 52281 with 52282 OCE edit 2033Urethral StrictureICD-9598.00598.01598.1DescriptionCPTShort DescriptionSIAPCUrethral stricture due to unspecifiedinfectionUrethral stricture due to infectivediseases classified 360053601536055362053621Cystoscopy and treatmentCystoscopy, implant stentCystoscopy and treatmentCystoscopy and treatmentCystoscopy & revise urethraCystoscopy and treatmentIncision of urethraIncision of urethraIncision of urethraIncision of urethraRevise urethra, stage 1Revise urethra, stage 2Reconstruction of urethraReconstruction of urethraReconstruct urethra, stage 1Reconstruct urethra, stage 2Reconstruct urethra/bladderRevision of urethraDilate urethra strictureDilate urethra strictureDilate urethra strictureDilate urethra strictureDilate urethra 6101610166016601660166016801680168Traumatic urethral stricture598.2Postoperative urethral stricture598.8Other specified causes of urethralstricture598.9Urethral stricture, unspecifiedAHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved0168016801680168015601260161016501643417
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrethral Stricture Procedures Coding in ICD-9-CM Meatotomy (Incision into urethralmeatus) – 58.5 Urethroplasty Fat Implant – 59.72 Insertion of Tandem cuff – 58.99 Urethral Meatoplasty – 58.47 Reconstruction – 58.4635Urethral Stricture Procedures Coding in ICD-9-CM Dilation of Urethral Stricture By Cystourethroscopy (58.6) Dilation of Prostatic Urethra (Balloon) 60.95 Passage of filiform (58.6) Passage of Sound (58.6) Indications: Often the stricture is due toBPH (sequence BPH first).36AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved18
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrolithiasis May be due to Changes in physicochemical Genetic urinary stasis UTI or other causesAbout 10% ofmales in the USAdevelop kidneystones (NIH, 2007)37Urolithiasis A stone in the urinary system Nephrolithiasis (kidney) 592.0 Ureterolithiasis (ureter) 592.1 Hematuria and Renal Colic – Symptomsthat are integral to urolithiasis Coding Clinic, 3Q 1995, page 8 Coding Clinic, 1Q 1991, page 1138AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved19
Coding Urology (Male) us nephrostomy without fragmentationPercutaneous nephrostomy with fragmentationPercutaneous aspiration of kidney (pelvis)Transurethral removal of obstruction from ureter and renal pelvisUreterotomyUrethral catheterizationUltrasonic fragmentation of urinary stonesExtracorporeal shockwave lithotripsy [ESWL] of the kidney, ureter and/or bladderICD-9Description-Diagnosis594.0Calculus in diverticulum of bladder594.1Other calculus in bladder594.2594.8Calculus in urethraOther lower urinary tract calculusCalculus of lower urinary tract,unspecified594.939UrolithiasisShort DescriptionSI50060CPTRemoval of kidney stoneC50065Incision of kidneyC50070Incision of kidneyC50075Removal of kidney stoneC50080Removal of kidney stoneT042950081Removal of kidney stoneT042950120Exploration of kidneyC50125Explore and drain kidneyC50130Removal of kidney stoneC50590Fragmenting of kidney stoneT50610Removal of ureter stoneC50620Removal of ureter stoneC50630Removal of ureter stoneC52320Cystoscopy and treatmentT016252325Cystoscopy, stone removalT016252330Cystoscopy and treatmentT016252351Cystouretero & or pyeloscopeT016152352Cystouretero w/stone removeT016252353Cystouretero w/lithotripsyT0163AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights ReservedAPC01694020
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrolithiasis 50080 or 50081 are usuallypreceded with nephrostomyestablishmentFor nephrostomy establishmentperformed during a differentsession reportIf the tract is establishedthrough retrogradecystourethroscopy, report52334Report 50392 (if nephrostomy isleft in place for therapeuticpurposes) with appropriate S&I Lithotripsy is a unilateralprocedure CPT Assistant, August 2001p.10 Do not report 76000 inaddition to 50590 (lithotripsy,extracorporeal shock wave) See 52353 for cysto approach Reference CPT Assistant August2003 page 14.41Urolithiasis ESWL: Extracorporeal Shock WaveLithotripsy: (98.51) Most common treatment for kidneystones Treatment consists of shock wavesoutside the body traveling inside tobreak up the stone (calculus)42AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved21
Coding Urology (Male) ProceduresNotes/Comments/QuestionsUrolithiasis – 3Urolithiasis – Other Procedures Cystourethroscopywith stoneextraction (56.0)Stent Insertion(59.8)PercutaneousNephrostomy Removal ofcalculus by incision Ureterotomy 56.2Nephrotomy 55.01Cystotomy 57.19Urethrotomy 58.0 55.04 or 55.03 55.9244AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved22
Coding Urology (Male) ProceduresNotes/Comments/QuestionsDysfunction of the BladderCPT 50820CPT 5086045Dysfunction of the BladderA two-piece pouch system. The square barrier sticks to the skin.The pouch attaches to the barrierContinent diversion-CPT 5082546AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved23
Coding Urology (Male) ProceduresNotes/Comments/QuestionsPolling Question #3A patient is scheduled to undergo a calculus removalfrom the ureter but a severe stricture from theurethra is encountered and had to be dilated first.After, the scope was passed and the ureteral stonewas removed.What is the appropriate choice?*1 592.1, 598.8, 52352*2 592.1, 598.8, 52352 and 52281*3 592.1, 5228147MS-DRGs – Male Urinary System MCCs Acute renal failureAcute pancreatitisSepsisAcutepyelonephritis withlesion of renalmedullary necrosis CCs UTIAcute prostatitisHydronephrosisPyelonephritisAbscess of ProstatePriapismTorsion of Testes48AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved24
Coding Urology (Male) ProceduresNotes/Comments/QuestionsMS-DRG CategoriesMS – DRG 713TURP w CC or MCCRW 0.985TURP(No CCs)Old CMS DRG 337RW 0.5877(with CC)Old CMS DRG 336RW. 0.8576MS – DRG 714TURP w/o MCC or CCRW .671049MS-DRG CategoriesMS – DRG 668TransurethralProcedures w MCCRW 1.7208Transurethral Procedures(No CCs)Old CMS DRG 311RW 0.6552(with CC)Old CMS DRG 310RW 1.2131MS – DRG 669TransurethralProcedures w CCRW 1.2079MS – DRG 670Heart Failure w/o MCCor CCRW .883850AHIMA 2007 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved25
Coding Urology (Male) ProceduresNotes/Comments/QuestionsMS-DRG CategoriesMS – DRG 662Mi
Ms. Jurek has 25 years of ICD-9-CM and CPT coding experience in a variety of healthcare settings. She is currently a full-time associate professor for the HIT program at Erie Community College and President of Jean Jurek Associates Inc., a medical coding and consulting company. Jerome Ndayishimiye, MS, RHIA, CIC
