Urology Coding Alert

Get a grip on the new bundles before reporting your next prostatectomy

Each quarter, coders brace themselves for the latest round of Correct Coding Initiative ( CCI ) edits, and this quarter version 13.3 hits urology coders especially hard with thousands of catheterization bundles.

Let our experts help you sort through the myriad of urology bundles you need to incorporate as of Oct. 1.

Limit Your Separate Catheterization Coding

CCI 13.3 bundles 51701-51703 (Insertion of non-indwelling and indwelling bladder catheter ) with an astounding 4,638 codes each. You won't be able to report the three urethral catheterization codes with most codes in the 10040 to 69970 range.

Good news: Because many of the bundles have a modifier indicator of "1," you can use a modifier to override many of these edits. You'll need a good reason, however, to justify billing 51701-51703 separately with most surgical and diagnostic codes.

Tip: You'd mostly use 51701 for a temporary catheter insertion when the patient is having trouble voiding urine and the doctor wants to measure postvoiding residual urine. You're unlikely to need to bill 51701 separately during a procedure, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook.

"These new bundles are not surprising," Ferragamo says. "They simply clarify that you cannot perform the surgery and expect to be paid separately for a related catheterization."

Exception: If the physician performs a surgical procedure and then later in the day the patient is retaining urine, you could bill for the catheterization separately under these circumstances, Ferragamo says.

"I only unbundle them when they are done at a separate session or for a different reason from the procedure," says Kelly Young, a coder with Scottsdale Center for Urology in Scottsdale, Ariz.

Example: If your urologist inserts a Foley catheter for urinary drainage in the operating room just before or after he performs a radical nephrectomy, you cannot separately report 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) since CCI includes the catheterization in the nephrectomy code, Ferragamo says.

Alternatively, if the urologist performed the catheterization later that same evening in the recovery room or in the patient's hospital room, you could separately report 51702 using either modifier 59 (Distinct procedural service) or modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) depending on the clinical circumstances and your case documentation.

You would use 51702 and 51703 for a temporary indwelling catheter, says Margaret Atkinson, business manager with Centennial Surgery Center in Voorhees, N.J. If your physician inserts one of these catheters, you should ask, "why?" Is it related to the surgical procedure? Or does the doctor routinely place a catheter at the end of all of his procedures? In these cases, you wouldn't unbundle 51702.

Remember: You use 51703 for a "difficult catheterization," which requires extra physician skill and work, says Alice Kater with Allied Physicians of Michiana in South Bend, Ind. Another option is if the physician has trouble catheterizing a patient during a procedure that requires a catheterization, you can append modifier 22 (Unusual procedural services) to the surgical CPT and send a brief note and a copy of the operative report to substantiate the request for additional reimbursement, Kater says.

Alter Your Prostate Surgery Thinking, Too

This latest round of CCI edits also comes down hard on prostate surgery codes. Starting Oct. 1, transurethral resection of the prostate (TURP) code 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) became mutually exclusive to transurethral prostatic surgery codes 52606-52648 and minimally invasive prostatic surgery codes 53850-53853.

Bad news: These edits have an indicator of "0" and cannot be bypassed at any time. In the past, you may have coded both a TURP and a photoselective vaporization of the prostate (PVP 52648, Laser vaporization of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]) procedure, for example. Starting this fall, you won't be able to, Ferragamo says.

CCI made 52606-52648 and 53850-53853 mutually exclusive of each other, and 52606-52648 are also mutually exclusive with prostate destruction codes 53850-53852. In addition, 55801-55810 and 55821-55831 are now mutually exclusive with 55840-55845.

And 55821-55831 also became mutually exclusive with most of the other prostatectomy codes. To complete the total ban, 55840-55845 are mutually exclusive with some of the lower-level prostatectomy codes.

Bottom line: If you're billing for prostate surgeries, you won't be able to bill for prostate destruction or prostatectomy on the same day--even with a modifier.

Example: If your surgeon first tries to do a transurethral prostate resection (52601) and then later during the same session decides to remove the prostate via an open approach (55821), you should report just the open prostatectomy.