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 [...]