CODING Tips and Tricks

The CPT code set is continuously being updated, with new Category I codes being released on January 1 of each year, and Category III codes being released on January 1 and July 1 of each year. Here are CPT code updates for which urologists and coders should be aware.

New Category I CPT Code: HIFU

CPT 55880: Ablation of Malignant Prostate Tissue Using Transrectal High Intensity Focused Ultrasound (HIFU)

HIFU was FDA approved in October 2015 for ablation of prostate tissue . Clinically, HIFU is used to ablate prostate cancer and has been used for both initial treatment and recurrence after prior therapy (radiation, laser, cryoablation etc).

Ablation of prostate cancer using HIFU was not previously described in the CPT code set and an unlisted code (CPT 55899) was recommended to be used to report HIFU treatment. HIFU had sufficient literature base and sufficient volume in the United States to warrant a new, separate CPT code. (Note: the Centers for Medicare & Medicaid Services had created HCPCS code C9747 for Hospital Outpatient Department and Ambulatory Surgical Center facility fees when performing HIFU, but this is not a CPT code itself.)

Starting January 1, 2021, HIFU will be reported using CPT code 55800. Please note that included in the procedure and not reported separately is CPT code 76942 Ultrasonic guidance for needle placement (eg biopsy, aspiration, injection, localization device), imaging supervision and interpretation.

Revised Category I CPT Code: Antegrade Urography

CPT 74425: Urography, antegrade

CPT code 74425 has been revised for the 2021 CPT code set. Previously it described uses for the code in its descriptor including the words “pyelostogram,” “nephrostogram” and “loopogram.” In 2016 CPT codes 50398 exchange of a percutaneous nephrostomy catheter and 74425 antegrade urography were combined and revalued as they were commonly reported together. This ultimately led to confusion regarding the other intended uses for CPT code 74425 and whether the descriptor was now accurate, as the most commonly used code with 74425 was 50398, and that new radiology codes typically include radiologic supervision and interpretation when performed.

Therefore, CPT code 74425 was revised with notes giving instructions that CPT 74425 can be used with CPT codes 50390 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous, 50396 Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter, 50684 Injection procedure for ureterography or ureteropyelography through ureterostomy or indwelling ureteral catheter, and 50690 Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service, but to not report CPT 74425 with CPT codes 50430, 50431, 50432, 50433, 50434, 50435, 50693, 50694 and 50695.

Please note that, if performing an injection for visualization of an ileal conduit, CPT code 74425 should be used if the catheter for injection is placed to the back end of the conduit for antegrade injection (with the flow of urine), and CPT 74420 urography, retrograde should be used if the catheter is placed at the distal end of the conduit and the contrast is injected in a retrograde fashion (against the flow of urine).

New Category III CPT Code: Prostate Commissurotomy with Drug Delivery

CPT 0619T: Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed.

The Category III CPT code 0619T describes a drug coated balloon dilation system used for men with benign prostatic hyperplasia. The system combines a controlled pressure dilation of the prostatic channel with the delivery of an antiproliferative drug into the prostatic bed, which may facilitate the long-term treatment of benign prostatic hyperplasia.

This procedure is unique and not currently described in the CPT code set. Parenthetical notes instruct the coder to not report CPT codes 52000, 52441, 52442, 52450, 52500, 52601, 52630, 52640, 52647, 52648, 52649, 53850, 53852, 53854, 76872 or 0499T in conjunction with 0619T.

New Category III Codes: Female Intraurethral Valve-Pump Insertion and Replacement

CPT 0596TTemporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion including urethral measurement

CPT 0597TTemporary female intraurethral valve-pump (ie voiding prosthesis); replacement

Two new Category III codes were created to describe the initial insertion of a female intraurethral valve-pump and for the replacement of a pump. These codes were created as there were no codes to describe the procedure of initial measurement and placement of a voiding prosthesis or the replacement of the device.

Prior to the establishment of these codes, CPT code 53899, Unlisted procedure, urinary system was used to report this work (with HCPCS code A4335, Incontinence supply; miscellaneous for the valve-pump and activation wand). While there is a similar CPT code 53855 Insertion of a temporary prostatic urethral stent, including urethral measurement, this is a male code (prostatic) only. The degree of difficulty in determining urethral measurement and of urethral insertion in men vs women made it necessary for a separate code for female urethral device insertion.

Temporary female intraurethral valve-pump (ie voiding prosthesis) is indicated for adult women with urinary retention due to impaired detrusor contractility, which is typically the result of neurological disease or injury (advanced multiple sclerosis, spinal cord injury, spina bifida, multiple system atrophy etc); for patients with urinary retention due to clean intermittent catheterization indwelling catheterization, or urinary diversion; and women who cannot perform clean intermittent catheterization due to functional limitations because of underlying medical conditions. Indwelling catheters are associated with recurrent infections and decreased quality of life, and diversion is life altering. The parenthetical notes placed onto these codes describe that, when performed, these codes should not be reported with CPT codes 51610, 51700, 51701, 51702, 51703 or 51705.