The Current Procedural Terminology (CPT) code set is updated each January 1st. It is important that urologists understand these updates. CPT coding changes that are of interest to urology for January 1, 2023, include revisions to the CPT codes for percutaneous nephrolithotomy, the creation of a new code for laparoscopic simple prostatectomy, changes to the code set for removal of sutures or staples, the creation of new category III codes for transperineal laser ablation of benign prostatic hyperplasia (BPH), and magnetic field induction ablation of malignant prostate tissue, and the sundowning of a category III code for mechanical dilation and urethral therapeutic drug delivery for urethral stricture (see Table). The details are described below.

Table. New, Revised, and Deleted Category I and Category III Current Procedural Terminology Codes of Interest to Urology Starting January 1, 2023

Revision Category I CPT Codes 50080 and 50081 for Percutaneous Nephrolithotomy

Old descriptor (for dates of service before January 1, 2023):

• 50080 Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction up to 2 cm
• 50081 …>2 cm

New descriptor (for dates of service on or after January 1, 2023):

• 50080 Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement, and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
• 50081 …complex (eg, stone[s] >2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)

CPT codes 50080 and 50081 were updated to provide more granularity, and the revised desciptor includes terminology that more accurately reflects current clinical practice. They were also revalued. The outdated terms “nephrostolithotomy” and “pyelostolithotomy” were replaced with the more commonly used “nephrolithotomy” and “pyelolithotomy.” The ambiguous term “endoscopy” was replaced with the more granular term “antegrade ureteroscopy” to clarify that these codes encompass all work done antegrade (including antegrade ureteroscopy and antegrade stent placement, if performed) but that procedures performed retrograde (from the bladder) are not part of these codes. Nephrostomy tube placement and imaging guidance were added to the descriptor, and the term “basket extraction” was replaced with a more general term “stone extraction.” The “with or without” language was replaced with the more granular words “when performed.” Dilation of the tract was removed from the descriptor due to the overlap with CPT codes 50436 and 50437 so that the dilation procedures (dilation without and with new access, respectively) are reported separately if performed by the same surgeon at the same setting.

As before, CPT code 50080 should be reported for stone(s) up to 2 cm but now clarified to be in a single location of the kidney or renal pelvis, while CPT code 50081 should be reported for complex procedures such as for removing stone(s) greater than 2 cm, branching stones, stones in multiple locations, stones in the ureter, or in patients with complicated anatomy.

When the procedure described by 50080 or 50081 is performed bilaterally (ie, on both kidneys), 1 unit is reported with modifier 50, “Bilateral procedure,” appended. In the instance when CPT code 50080 is performed on 1 side and 50081 is performed in the contralateral kidney, modifier 50 would not be appended. Placement of additional accesses, if needed, and removal of stones through other approaches (eg, open or retrograde) may be reported separately if performed.

New Category I CPT Code 55867 for Laparoscopic Simple Prosatatectomy

CPT code 55867 describes “Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed.” This code was created to report a laparoscopic “simple” prostatectomy. Previously an unlisted code was used to report that service. This code was created to differentiate this procedure from that of a “simple” prostatectomy performed by an open approach (reported using CPT codes 55831 and 55821 for the retropubic and suprapubic approaches, respectively), open radical prostatectomy (CPT codes 55840, 55842, and 55845), and laparoscopic radical prostatectomy (55866). Previously an unlisted code was used to report that service.

New Category III Codes

Category III codes are tracking codes used to report performing procedures that are new and emerging technologies. Category III code 0X96T was created to report “Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance,” while 2 cateogry III CPT codes were established to report magnetic field induction ablation of malignant prostate tissue, CPT code 0X38T, “Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed MRI examination,” and code 0X39T, “Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation.”

New, Revised, and Deleted Category I Codes for Suture Removal Procedures

Old codes and descriptors (for dates of service before January 1, 2023):

• 15850 Removal of sutures under anesthesia (other than local), same surgeon
• 15851 Removal of sutures under anesthesia (other than local), other surgeon

New codes and descriptors (for dates of service on or after January 1, 2023):

• 15851 Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation)
• +15853 Removal of sutures or staples not requiring anesthesia (List separately in addition to Evaluation and Management [E/M] code)
• +15854 Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code)

CPT codes 15850 and 15851 had described suture removal under anesthesia by the same or different surgeon, respectively. For 2023, CPT code 15850 will be deleted, and code 15851 revised with the removal of the reference to “other surgeon” but include clarification that it describes suture or staple removal requiring general anesthesia or moderate sedation. Add-on codes 15853 and 15854 were established suture or staple removal not requiring anesthesia, and suture and staple removal not requiring anesthesia, respectively. Codes 15853 and 15854 are add-on codes to be reported with E/M service codes (eg, CPT 99202-99205, 99212-99215, 99281-99285, 99341-99342, 99344-99345, 99347-99350) to account for the expenses of this work that are not inherent in the E/M codes. Parenthetical notes describe restricting the reporting of codes 15853 and 15854 together, and that CPT code 15851 is not intended to report suture and/or staple removal to reopen a wound prior to performing another procedure through the same incision. Suture and staple removal is included as part of the global period, so should only be reported if suture or staples are removed outside of a global period.