Urology Coding Alert
Add These 43653/44005 Bundles to Your List of Coding No-No's
The ‘0’ modifier indicator means no exceptions
“The thing that stands out to me is the addition of an exclusion for open lysis of adhesions with many laparoscopic procedures,” says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis. “This is consistent with the inclusion of adhesion lysis with pretty much all surgical encounters, but also corrects the use of an open procedure with a laparoscopic, which is not allowed in CPT if both are laparoscopic.”
The latest round of Correct Coding Initiative (CCI) edits bundles adhesion lysis with several urology codes you use, and you won’t be able to overcome the bundles using modifiers.
Version 13.2, effective July 1, adds the following new bundles that you’ll need to take into account for your urology coding:
• CCI Edits bundles 43653 (Laparoscopy, surgical; gastrostomy, without constriction of gastric tube ... [separate procedure]) into the following laparoscopic procedures: 50541 and 50544-50548 (renal laparoscopic surgery), 50945-50948 (laparoscopic ureteral surgery), 51990-51992 (laparoscopic urethral surgery), 54690-54692 (laparoscopic testicular surgery), 55550 (laparoscopic ligation of spermatic veins), and 55866 (laparoscopic radical prostatectomy). These edits have a modifier indicator of “0,” so you cannot override the bundles with any modifier regardless of the circumstances.
• CCI also bundles 44005 (Enterolysis ... [separate procedure]), an open procedure, into the same laparoscopic codes as the bundles listed above. These edits also have a modifier indicator of “0,” telling you that you cannot unbundle with any modifier.
Good news: The urology codes you use escaped major overhaul in this latest round of edits. “These few new CCI edits are not especially meaningful to urologists, who will rarely perform these ancillary procedures along with their laparoscopic procedures,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook.
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