Do you own or manage a urology practice? If yes, read this blog to learn the list of top urology CPT codes for 2024.
When assigning CPT codes for urology procedures, there are instances where the service provided doesn’t precisely match an existing code. Reporting the procedure using the relevant unlisted urology CPT code is appropriate in such cases.
One primary reason for resorting to an unlisted procedure code is the utilization of advanced techniques. Increasingly, providers are employing laparoscopic methods, often with robotic assistance, for procedures that were traditionally open. Since CPT codes specify “any open technique,” an unlisted code becomes necessary for these cases. For example, if a procedure such as CPT 51596 involving cystectomy with continent diversion using any open technique is performed laparoscopically, it cannot be billed using this code. Instead, code 51999 should be used in parallel with the comparable code 51596.
Reporting an unlisted procedure entails additional steps, both before and after submitting a claim for payment, to ensure accurate processing and reimbursement.
Below are essential steps to streamline the use of urology CPT codes:
- Whenever possible, seek prior authorization from the payer before performing the procedure.
- Ensure thorough and precise documentation of the service in the medical record, describing the procedure performed and supporting its medical necessity.
- Select the unlisted code from the appropriate anatomical CPT list. For instance, an unlisted procedure on the bladder should be reported with CPT 51999.
- Use a comparable procedure’s CPT code as a reference when establishing the fee for the unlisted code, adjusting it based on the relative complexity of the performed procedure.
- You can provide a description of the procedure in item 19 on the CMS-1500 claim form.
- Proactively follow up with payers, as additional information may be required, or you may need to appeal an initial claim denial.
- While billing for unlisted procedure services may involve additional effort, adhering to payer requirements and providing comprehensive procedure details can expedite claim processing and payment turnaround times.
New, Revised and Deleted CPT codes for urology with effect from January 1, 2024 – Source ( American Urology Association)
| CPT code | Action | Descriptor |
| 64590 | Revised Category I code | Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver |
| 64595 | Revised Category I code | Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array |
| 99459 | New Category I code | Female pelvic exam (list separately in addition to code for primary procedure) |
| 52284 | New Category I code | Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy |
| 0816T | New Category III code | Open insertion or replacement of integrated neurostimulation system for bladder dysfunction, including electrode(s) (e.g., array or leadless) and pulse generator or receiver, including analysis, programming, and imaging guidance when performed, posterior tibial nerve; subcutaneous |
| 0817T | New Category III code | …subfascial |
| 0818T | New Category III code | Revision or removal of an integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subcutaneous |
| 0819T | New Category III code | …subfascial |
| 0811T | New Category III code | Remote multiday complex uroflowmetry (e.g., calibrated electronic equipment); setup and patient education on the use of equipment |
| 0812T | New Category III code | Device supply with automated report generation, up to 10 d |
| 0864T | New Category III code | Low-intensity extracorporeal shock wave therapy involving corpus cavernosum |
CPT 64590: Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling
CPT 64595: Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver
Revised descriptors (changes in bold; used for dates of service on or after January 1, 2024):
CPT 64590: Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver.
CPT 64595: Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array
CPT 99459: Female pelvic exam (list separately in addition to code for primary procedure)
CPT 52284: Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when performed.
CPT 0816T: Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance when performed, posterior tibial nerve; subcutaneous
CPT 0817T: Open insertion or replacement….subfascial
CPT 0818T: Revision or removal…. subcutaneous
CPT 0819T: Revision or removal….subfascial
CPT 0587T: Percutaneous implantation or replacement of integrated single-device neurostimulation system for bladder dysfunction, including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
CPT 0588T: Revision or removal
Parentheticals are noted that instruct one not to report codes 0816T through 0819T in conjunction with codes 64555, 64566, 64575, 64590, 64596, 95970, 95971, 95972, 0588T, 0589T, and 0590T.
CPT 0589T: Electronic analysis with simple programming of an implanted integrated neurostimulation system for bladder dysfunction (eg, electrode array and receiver)… posterior tibial nerve, 1-3 parameters
CPT 0590T: … 4 or more parameters
Codes 0589T and 0590T are used to report programming for either an open or percutaneous device targeting the tibial nerve.
CPT 0786T: Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed
CPT 0788T: Revision or removal …
CPT 0789T: Electronic analysis with simple programming of implanted integrated neurostimulation system (e.g., electrode array and receiver)… spinal cord or sacral nerve, 1-3 parameters
CPT 0790T: …4 or more parameters
CPT 0811T: Remote multiday complex uroflowmetry (e.g., calibrated electronic equipment); setup and patient education on the use of equipment.
CPT 0812T: Device supply with automated report generation, up to 10 days
CPT 0864T: Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy.
The above list of codes is not a comprehensive listing of urology CPT codes in urology but a listing of the commonly used codes. We would be happy to help you improve the revenues of your urology practice. Contact us today for more information.
