![]() Urologists should consult with commercial payer or Medicare representatives to determine the most appropriate coding. The primary HCPCS code for denosumab (Prolia) is J0897, plus CPT code 96372 (therapeutic, prophylactic, or diagnostic injection) or CPT code 96401 (chemotherapy-associated code). Select an appropriate infusion CPT code (96413-96415 or 96365-96366), depending on the length of the infusion. ProvengeĬlaims for sipuleucel-T (Provenge) must be associated with the International Classification of Diseases, Tenth Revision ( ICD-10) code C61 (malignant neoplasm of the prostate) and ≥1 ICD-10 codes from C77.1 to C79.82 (bone metastasis, documented in medical record), in addition to the Provenge-specific HCPCS code Q2043. The third visit is covered by CPT code 99024 (postoperative visit). The second session is covered by the HCPCS code J0775 or CPT codes 54200 to 54258. The initial visit can be associated with CPT and the Healthcare Common Procedure Coding System (HCPCS) codes 54235 (injection into the corpora cavernosa with a pharmacologic agent), 96372 (therapeutic, prophylactic, or diagnostic injection), J0775 (Xiaflex injection), or 54200 (injection procedure for Peyronie’s disease). Xiaflex InjectionsĪ course of treatment with collagenase clostridium histolyticum (Xiaflex) entails 3 visits. The urologist may then appeal the claim and equate the procedure to an MRI biopsy. Alternatively, urologists may submit a claim associated with CPT code 76498 (unlisted MRI procedure), which will be automatically denied. Urologist claims associated with CPT code 77021 (MRI guidance for needle placement) will be denied. MRI Fusion Prostate BiopsyĬurrently, no code exists for incorporating magnetic resonance imaging (MRI) fusion into prostate biopsies. It all comes down to who submits a claim first,” said Ms Maldonado. If the hospital bills first, the hospital gets paid, and the urologist’s claim will be denied. However, because this is a radiologic procedure, the hospital can also bill. “When the procedure is done in hospital, a physician who has separate documentation can bill for the retrograde pyelogram interpretation with the 26 modifier. A retrograde pyelogram represents one common area of confusion. Separate documentation is not required, but, at the very least, a separate paragraph covering image interpretation should be included in the report. ![]() When a surgical procedure includes imaging guidance, supervision, or interpretation, a written report, signed by the person who interpreted the image, should be included. This is just difference of opinion, differences in how we read and interpret the note,” said Edna Maldonado, CPC, ACS-UR, Coding Coordinator, Practice Management Department, American Urological Association (AUA), Lithicum, MD.ĭuring her presentation at the 2016 AUA Practice Management Conference, Ms Maldonado reviewed some of the problem areas that have come to the attention of coding consultants for the AUA coding hotline. “We could put several coders in a room with one operative note, and we could probably come away with four or five different codes. Whether Current Procedural Terminology ( CPT) coding for urology practice qualifies as an art form is debatable, but the adage “the code is in the eye of the beholder” definitely applies.
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