How do you code for percutaneous cystolithotomy, removal of multiple bladder stones via a suprapubic tract?
Based on your question, we are going to assume you are using a cystoscope that is inserted through an established suprapubic tract to locate and remove the stones. The suprapubic tract is, in fact, functioning as a de facto urethra. Therefore, code 52315—”Cysto- urethroscopy, with re- moval of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated”—is the correct code. We recommend this code based on the comment that you removed multiple stones, as opposed to code 52310—”Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple”—which would be more appropriate for removal of fewer stones. If your operative note indicates that the operation does not justify the complicated code, use 52310.
If, on the other hand, you are removing the stones without the cystoscope, code 51050—”Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection”—is the appropriate code.
We are being asked by general surgeons to put ureteral stents in a patient who has diverticulitis so that the ureters will be more prominent during surgery. Since this isn’t a urologic problem, should we bill for this condition? If so, should we use a modifier?
Yes, you can bill for the services you provide. We recommend that you use the diagnosis code for the disease process for which the general surgeon is providing service if there is no other reason for the stent insertion. Medicare has no local carrier decisions that would prevent payment based on the diagnosis. If it’s denied, appeal.
What is the appropriate way to code for the stimulation of the pelvic floor using percutaneous stimulation of the tibial nerve?
The American Medical Association has recommended code 64555—”Percutaneous implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)”—for the performance of this procedure. Although the code is not exact in its description of the service provided, this code is reasonable in the AMA’s opinion.
However, it should be pointed out that carriers are not required to follow the AMA’s opinion, and at least one payer has decided that the service should be coded and paid under 64550—”Application of surface (transcutaneous) neurostimulator.” This code is also not accurate, but the payer can rule it appropriate until a more accurate code is developed.
It should also be noted that code 64999—”Unlisted procedure, nervous system”—is also considered an option by AUA. Physician Reimbursement Systems’ http://DeviceCoding.com/ contains more discussion of the appropriate coding for this service, and can be referred to for ongoing information relative to this and other new device services and coding. Manufacturer information is also available on reporting for the device. As with any device, carefully consider the accuracy of the information provided by a manufacturer before billing any service that does not have an obvious code in the CPT or Healthcare Common Procedure Coding System.
How do I code for the use of radiofrequency revision of pelvic ligament for incontinence?
Currently, there is no code available for this service. The manufacturer of the device used to perform this service is applying for a code for it. A category III code could be established as early as July of this year.
Until such time as a category III code or a category I code is developed, the most accurate reporting code for the device is the unlisted code, 53899. With unlisted code documentation, you should be providing procedural performance, medical necessity, and justification of charge. Unlisted codes are normally considered for payment on a case-by-case basis by each payer.
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.