Urology Coding Alert

The good news: None of the edits will be a big drain on your reimbursement.

If the news about the huge set of new Correct Coding Initiative (CCI) edits for this quarter has your head spinning, dont worry. Youll only have a few edit pairs to worry about in your urology practice. Let our experts help you narrow your focus.

Edits Focus on Just 524 Unique Codes

Version 15.1, effective April 1, contains 304,038 additions. This has increased the total present-day CCI database to 629,107 edit pairs.

The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

On the plus side: These edits are not major changes and certainly will not change urology coding  significantly, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

Despite the numerous edits, CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list,and only 48 codes make up the top 80 percent of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in a March 12 news release.

The top most commonly occurring codes in column 2 of the new non-mutually exclusive edits are 94250 (Expired gas collection, quantitative ...), 94680-94690 (Oxygen uptake, expired gas analysis ...), 95812-95819 (Electroencephalogram ...), and +96376 (Therapeutic, prophylactic, or diagnostic injection ...; each additional sequential intravenous push of the same substance/drug provided in a facility ...), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

Example: CCI bundles these codes into most of the procedures in the integumentary, musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

Most of the new edits bundle nerve block and injection codes (623xx and 644xx) into almost every surgical procedure code found in the 2009 CPT manual,Ferragamo adds.

Dig Into Urology-Related Bundles

CCI bundles cystourethroscopy ureteral stent insertion code 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) and change of percutaneous tube or drainage catheter code 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system,abscess], radiological supervision and interpretation) into 50385 (Removal [via snare/capture] and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation) and 50386 (Removal [via snare/capture] of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation).

These procedures, most often performed by a radiologist, by definition also include replacement of the stent and radiological services, hence the bundling,Ferragamo explains. These edits have a modifier indicator of 1, meaning that you can unbundle the edits with a modifier under the proper clinical circumstances.

Additionally: CCI now bundles laparoscopic appendectomies (44970) into the following laparoscopic urological procedures

" 50541-50544 (renal laparoscopy)

" 50547-50548 (renal laparoscopy)

" 51900 and 51992 (incontinence laparoscopy)

" 54690 (testis laparoscopy)

" 55550 (spermatic cord laparoscopy)

" 55866 (laparoscopic radical prostatectomy).

These edits also all have a modifier indicator of 1.Botox bundles: CCI includes injection codes 96360, 96365, 96372, 96374, and 96375 with 64640 (Destruction by neurolytic agent; other peripheral nerve or branch), all with a modifier indicator of 1. Some payers, such as the North Carolina and Idaho Medicare carriers, accept 64640 as proper coding for Botox bladder wall injections with a diagnosis of neurogenic bladder, 596.54 (Neurogenic bladder NOS).

Dont Code Tumor Destruction With Nephrectomy

Column 2 intra-abdominal tumor destruction code 49203 (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal,mesenteric, or retroperitoneal primary or secondary tumors &) is now bundled into column 1 nephrectomy codes 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) and 50234 (Nephrectomy with total ureterectomy and bladder cuff;through same incision).

CCI 15.1 also bundles column 2 codes 50280 (cyst excision) and 50592 (renal tumor ablation) into 49203.Plus, CCI bundles codes 50280, 50592, 50230, and 50234 with 49204-49205.

What it means: Therefore, in most cases, one should not bill both the treatment of intra-abdominal tumors and separately bill for kidney procedures at the same operative encounter, Ferragamo says. All of these edits have a modifier indicator of 1, so you can unbundle the codes if the clinical circumstances warrant separate coding.

Urogynecology Also Faces Changes

In CCI 15.1 youll find several new bundles involving paravaginal defect repairs, including:

" Abdominal approach: Code 57284 (Paravaginal defect repair [including repair of cystocele, if performed]; open abdominal approach) now bundles 44055, 49320,57423, and 58660 with a modifier indicator of 0, meaning you can never bypass these edits with any modifier. Also bundled into 57284 are 43653, 44180, 44820, 44850, 49000-49010, 49255, 49570, and 51715. These edit pairs have a modifier indicator of 1.

" Vaginal approach: Code 57285 (& vaginal approach) includes column 2 bundled codes 51780,57268, and 57415 with a modifier indicator of 0.Bundles between 57285 and 51701-51703, 57020, 57100,57400, 57410, 57420, 57423, 57452, 57500, 57530, 57800, 58100, and P9612 all have a modifier indicator of 1.

" Laparoscopic approach: Code 57423 (Paravaginal defect repair [including repair of cystocele, if performed],laparoscopic approach) bundles column 2 codes 44180,51701, 51702, 57410, and 58660, with a modifier indicator of 1.