Urology Coding Alert

You'll now find 76000-76001 bundled with many urological procedures.

The last quarterly update of Correct Coding Initiative (CCI) edits doesn't spare your urology coding. Make sure you're up to speed on the latest bundles so you don't rake in denials on claims involving conscious sedation and fluoroscopy.

Put Moderate Sedation at the Top of Your Updates

There are 18,320 new edits in the most recent version, 15.3, which took effect on Oct. 1, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

Roughly 80 percent of the new bundles relate to moderate sedation codes 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...), according to the Sept. 11 "NCCI 15.3 Update" news release by Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla.

CCI bundles column 2 moderate sedation codes 99148-99150 into all urinary column 1 codes, such as 52000 (Cystourethroscopy [separate procedure]) and 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrostomy are included]), with modifier indicator "0."

This means you cannot override these edits with a modifier.

You'll also find that CCI now bundles 99148-99150 in all male genital system codes, such as 54100 (Biopsy of penis; separate procedure) and 54161 (Circumcision, surgical excision other than clamp, device or dorsal slit; older than 28 days of age).

The modifier indicator for all of these new bundles is "1," meaning that you can override these edits with a modifier, such as 59 (Distinct procedural service), under the proper circumstances. (For more on properly using modifier 59 to override CCI bundling edits, see "Navigate Your Way to Proper Modifier 59 Use With This Chart" on page 91.)

Good news: Unless your urologist is acting as a second surgeon administering the anesthesia -- which would be extremely rare -- you won't face lost reimbursement because of these new edits, says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. As the 99148-99150 code descriptors state, these codes describe sedation by a second physician -- not by the physician performing the diagnostic or therapeutic service. So these edits shouldn't change how you code your claims for procedures, Hollingshead suggests.

Exception: CCI does not include add-on codes in these moderate sedation bundles. You also won't find 50021 (Drainage of perirenal or renal abscess; percutaneous), 50382-50387 (stent removal/replacement codes), or 50593 (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy) among the moderate sedation bundles, Ferragamo explains. CCI instead bundles just 99145 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status ...) and 99150 into these codes. All of these bundles also have a modifier indicator of "0."

Beware of Multiple New Fluoroscopic Bundles

In addition to the moderate sedation edits, you'll want to pay attention to several new fluoroscopy bundlings. CCI bundles 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71024 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a nonradiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) into several urology procedure codes, Ferragamo says. These codes include:

• 50541-50548 (renal laparoscopy)

• 50951-50980 (ureteral endoscopy)

• 51990-51999 (bladder laparoscopy)

• 52010-52305 (cystoscopy)

• 52400-52700 (transurethral resection)

• 54690-54692 (laparoscopic orchiectomy and orchiopexy)

• 55550 (spermatic cord laparoscopy)

• 55866 (laparoscopic radical prostatectomy).

Don't miss: CCI also bundles 76000 into laparoscopic ureteral procedure codes 50945-50958 and 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots). All of these new fluoroscopy edits have a modifier indicator of "1," Ferragamo points out.

If your urologist uses fluoroscopy during a nephrostomy tube change (50398, Change of nephrostomy or pyelostomy tube) or a bladder aspiration procedure (51101-51102, Aspiration of bladder ...), you won't be able to report 76001. "These edits also have a modifier indicator of ‘1' and therefore, can be broken and billed with a modifier under the appropriate clinical circumstances," Ferragamo says.