Radiology Coding Alert

Find out which new angioplasty codes are under the NCCI microscope Step outside the 70000-range radiology-coding box, and you'll see dozens of new National Correct Coding Initiative edits affecting your coding this spring. Try these expert tips on recognizing legitimate opportunities to override edits when your provider performs separate, complete, medically necessary procedures. Do You Know When 59 Trumps UT Edits? NCCI version 13.1, which takes effect April 1, 2007, for physician claims and July 1, 2007, for hospital claims, bundles the following procedures into replacement (50382) and removal (50384) of an internal ureteral stent, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.:

 • Replacement of externally accessible ureteral stent (50387)
 • Injection of renal pelvis (50390)
 • Percutaneous nephrostomy (50392, 74475)
 • Placement of ureteral stent (50393, 74480)
 • Nephrostogram injection (50394)
 • Replacement of ureteral stent via ileal conduit (50688). You should bundle the following procedures into replacement of externally accessible ureteral stent (50387) under NCCI 13.1, Miller says:
 • Percutaneous nephrostomy (50392, 74475)
 • Placement of ureteral stent (50393, 74480)
 • Nephrostogram injection (50394)
 • Dilation of nephrostomy tract (50395, 74485)
 • Change of nephrostomy tube (50398)
 • Change of ureteral stent via ileal conduit (50688). NCCI 13.1 bundles the following procedures into nephrostomy tube removal under fluoro guidance (50389), she says:
 • Placement of ureteral stent (50393)
 • Nephrostogram injection (50394)
 • Fluoro guidance (77002).
 Finally, replacement of internal ureteral stent (50382) is bundled into stone extraction via nephrostomy (50080, 50081), Miller says. 
 
Note: All of these edits have a modifier indicator of "1," which means you can use a modifier, such as 59 (Distinct procedural service), to bypass the edit. Modifier 59 tells the payer that the procedures were not components of one another but were both medically necessary and separate from one another, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky. 3 Urinary Tract Edits That Could Trip You Up The most problematic of all the new urinary code edits will be those for the percutaneous urinary tract procedures, such as ureteral stents and nephrostomy, Miller says.
 
You may be accustomed to reporting these code pairs together when providers perform the following services, Miller says:
 
1. different procedures on each side simultaneously for patients with drainage tubes on both the left side and right side
 
2. several therapeutic procedures on one side during the same encounter
 
3. a diagnostic study (antegrade pyelogram or nephrostogram) before stent or catheter placement.
 
Because all of these edits are modifier status "1," you need to evaluate each case individually to determine whether overriding the edit is appropriate, she says.
 
Example: With NCCI 13.1, you may report 50394 (column 2) along with ureteral stent replacement (50382 or 50387; column 1) only when the documentation supports a complete, medically [...]