Coding laser ablation, robotic RP: Consider these points
The current CPT terminology does focus specifically on the results of the laser and not the laser itself.
Q. My question concerns coding for prostate laser ablation. The physician performs a Holmium laser ablation of the prostate. Does Holmium ablation always mean coagulation, or can Holmium laser also be used for vaporization? The physician does not use that terminology, and I seem to be at an unlisted CPT code.
Q. I am trying to verify that we are coding laparoscopic robotic prostatectomy correctly. I spoke with our local Medicare carrier representative last week and was told to use the unlisted code 55899 for the primary surgeon and use 55866/80 for the assistant. We have been using the unlisted code for both the primary and the assistant surgeons, and the assistant surgeon's claims have all been denied. We have appealed these denials, but do not know the outcome yet.
Q. How do I charge for the new TargetScan 3-D prostate needle biopsy?
If you are doing the "saturation biopsy" or "prostate mapping" as defined by the tracking code 0137T, you are required to charge that code instead of the prostatic needle biopsy (55700) and the ultrasound guidance (76947) codes. Remember that you have to negotiate the payment for that code as you do for an unlisted code, since there is no payment attached in the Medicare fee schedule.
Q. I just recently read your article about using the 1995 E&M documentation guidelines rather than the 1997 guidelines (Urology Times, October 2005). I printed off both physical exam forms, but I am confused on the meaning of the term "elements" in the 1995 guidelines. A limited exam requires that one to three elements be examined and documented for the affected organ system. Does this mean that if the physician examines one organ (eg, DRE) listed on the form, he could choose a level 3 for the PE portion?
A. The 1995 guidelines do not have listed elements or proscribed counts per se; the interpretation of one to three elements is based on the definition of "limited" in the history section of the guidelines. Thus, one element on the affected organ system is sufficient for a limited affected organ system examination.
Potential code for prior authorizations on AMA CPT Editorial Panel meeting agenda
March 28th 2024"Good public and economic policy must align costs, benefits, and incentives; currently, all costs are incurred by physician practices, and all financial savings and benefits from prior authorization accrue to health insurance plans, leading to perverse incentives,” says Alex Shteynshlyuger, MD.
