Urology Coding Alert

CCI doesn't spare new urodynamics codes, but you can break most bundles.

While you're still trying to take in all the 2010 CPT Changes , the new edition of the Correct Coding Initiative ( CCI ), effective Jan.1, 2010, is already tying your hands on some code pairings, including the new 2010 urodynamics codes.

Version 16.0 introduces 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc. But don't worry; you won't have to sort through all those changes. We've done it for you. To keep your urology practice on the up and up this quarter, here's what you need to know.

Avoid Double Billing for Stents

CCI 16.0 bundles new 2010 CPT code 53855 (Insertion of a temporary prostatic urethral stent, including urethral measurement) into 52282 (Cystourethroscopy with insertion of a permanent stent). Medicare bases the edit on the rationale that 53855 and 52282 are mutually exclusive. That means payers who follow CCI will not reimburse your urologist for insertion of both a permanent stent and a temporary stent at the same time, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

This bundle has a modifier indicator of "1." That means you can bypass the CCI edit with a modifier, such as modifier 59 (Distinct procedural service), under the proper circumstances.

Example: You would be justified in reporting 52282 along with 53855-59 if your urologist performed the two stent insertions at different times or encounters on the same day. In this case, you should report both procedures and expect payment for both, Ferragamo says.

Check CCI Before Reporting Catheterizations with Urodynamics

Forget billing a basic catheterization along with the new 2010 urodynamic codes, according to CCI. Starting Jan.1 you won't be able to report 51701 (Insertion of non- indwelling bladder catheter [e.g., straight catheterization for residual urine]) with many procedural codes, including the following new urodynamics codes:

• 51727 -- Complex cystometrogram (i.e., calibrated electronic equipment); with urethral pressure profile studies (i.e., urethral closure pressure profile), any technique

• 51728 -- ... with voiding pressure studies (i.e., bladder voiding pressure), any technique

• 51729 -- ... with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique.

Relax: These bundlings don't come as a surprise and they mirror previous CCI edits, Ferragamo says. "As with all urodynamic procedural codes, catheterization is included in these studies and is not separately billable," he explains.

These edits also have a modifier indicator of "1." Therefore, you can override the edits with a modifier if clinically appropriate.

Example: A patient has a urodynamic study in the morning and then later that same day has difficulty voiding, requiring a single bladder catheterization. Bill for the urodynamic studies performed in the morning, and also bill 51701-59 for the single catheterization in the evening.

Additionally: You'll also find that CCI 16.0 bundles 50715 (Ureterolysis with or without repositioning of ureter for retroperitoneal fibrosis) with the new urodynamics codes 51727-51729. These three bundles also have a modifier indicator of "1."

Don't Get Your Hopes Up About Deletions

CCI 16.0 includes an extensive list of terminated code pairs, some of which affect urology. Don't expect any major impact, however. "The deletions primarily involve codes that were either deleted from CPT 2010 or the consultation codes that are no longer covered by Medicare," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Colo.

The urology-related edit eliminations apply to deleted urodynamics codes 51772 (Urethral pressure profile studies [UPP] [urethral closure pressure profile], any technique) and 51795 (Voiding pressure studies; bladder voiding pressure, any technique), plus consultation codes 99241-99245 (Office consultation for a new or established patient ...) and 99251-99255 (Inpatient consultation for a new or established patient ...).