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Urology Coding Alert

CCI 15.0 Update:

Ease the Burden of CCI 2009 Round 1 By Learning These 3 Themes

Published on Mon Jan 12, 2009

Checking the modifier indicator is your key to navigating the new edits.

As of Jan. 1, you should be using new CPT Codes 2009 codes -- but learning the new codes and when you should report them isn't the end of the story.

The Correct Coding Initiative (CCI), version 15.0, applies a slew of bundles to your coding practice, homing in on the new codes, and limiting what services you can report in conjunction with them. CCI 15.0 sets its sights on the new 2009 codes rather than adding many new edits for your established codes. Best of all, none of these edits should take a serious toll on your reimbursement bottom line. Here's what you need to know.

1. New Drug Administration Code Bundles Bring Mixed News

CCI bundles the new revised therapeutic, prophylactic, and diagnostic administration CPT codes 96360 (Intravenous infusion, hydration; initial, 31 minutes to 1 hour), 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour), 96372-96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug] ...) into most of the urological procedures in the 50010 to 55920 series.

Good news: The modifier indicator for all of these new bundles is "1," meaning that you can override these edits with a modifier under the proper circumstances. (For more on overriding CCI bundling edits, see "Learn When You Can Override CCI Edits, Legitimately" on page 19.)

Additionally: CCI 15.0 also bundles these administration codes with urogynecological procedure codes 57200 to 57335, as well as most codes found in the female genital system section of the CPT manual. As above, these bundles also have a modifier indicator of "1."

Same bundles, different codes: "These therapeutic, prophylactic, and diagnostic administration codes are replacing the 2008 CPT intravenous and injection codes90760, 90765, 90772, 90774, and 90775," explains Michael A. Ferragamo MD,FACS, assistant clinical professor of urology, State University of New York, University Hospital, Stony Brook, N.Y. "The bundling for the changed administration codes continue the same bundlings that were present for the old 2008 drug administration codes. However, these are new bundlings in the sense that there are now new (changed) administration codes."

2. Revised TURP Codes Get Hit, Too

Incorporate some new bundles for the 2009 revised "repeat" transurethral resection of the prostate (TURP) code 52630 (Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete [vasectomy, meatotomy,cystourethroscopy, urethral calibration and /or dilation, and internal urethrotomy are included]) into your coding.

In addition to previously cited CCI edits, 52630 now includes codes 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone,bladder neck, prostatic fossa, urethra, or periurethral glands), 52275 (Cystourethroscopy, with internal urethrotomy; male), 52276 (Cystourethroscopy with direct vision internal urethrotomy), and 55250 (Vasectomy,unilateral or bilateral [separate procedure], including postoperative semen examination[s]). The indicator for these recent edits is "1," Ferragamo points out.

Bad news: These new bundlings may make your job more difficult, even though you can use a modifier to break the bundles, says Becky Boone, CPC, CPC-URO, certified reimbursement assistant for the University of Missouri Department of Surgery in Columbia.

Coders and physicians will have to "prove that [the procedures] are separate when they should not be bundled at all in my opinion," Boone says. "This, from a coding standpoint, is going to be an issue as they continue to get rid of everyday codes. Take 52276: Why should this be bundled with 52630 when it is for DVIU [direct vision internal urethrotomy] and not prostatic regrowth? These areas are close but are two different areas, so they should not be considered bundled."

Boone also cites the 52630/55250 bundle as questionable. "Why are they bundling 52630 with a vasectomy (55250)?" she asks. "Again, this makes little sense since they are clearly two different areas. This is just another way that the doctors are going to be cut on billing and income amounts. Some insurers will make it extremely hard to bill for these codes together even if you can show they are separate, because the groundwork has been set" by the CCI edits, Boone laments.

3. Avoid Reporting Saturation Biopsies With Catheterization Codes

The new 2009 code 55706 (Biopsies, prostate, needle,transperineal, stereotactic template guided saturation sampling, including imaging guidance) now bundles with many codes (see the chart on page 20 for details). In particular, you should pay attention to the new bundles between 55706 and the three catheterization codes (51701 to 51703). CCI now bundles all three with 55706, and also now bundles the simple needle biopsy of the prostate (55700) into 55706.

"We hardly ever bill for a cath placement using 55700,but when we do we should be allowed to get paid for this," Boone says. "Now we have to prove they are separate just because the cath is placed at the same time as the biopsy (55706) is done."

Plus: Also newly bundled with 55706 are codes 76942 (Ultrasonic guidance for needle placement [e.g.,biopsy, aspiration, injection, localization device], imaging supervision and interpretation) and 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration,injection, localization device]).

Important: You also won't be able to report +69990 (Microsurgical techniques, requiring use of an operating microscope [List separately in addition to code for primary procedure]) with 55706 in 2009, thanks to CCI 15.0.

All of the new 55706 edits have an indicator of "1,"except the bundle with +69990. This bundle has an indicator of "0," meaning that you can never override this edit.

CCI 15.0 also includes edit deletions involving codes 52606, 52612, 52614, 52620, 53853, 61793, 90760-90779, and category III code 0137T. See the chart on page 20 for details on these deletions.

Want to learn more? To download a free copy of CCI 15.0 (or past CCI versions) go online to the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. 

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