Urology Coding Alert

Start capturing additional pay by separating wound care management codes 97597-97602 from the newly revised debridement codes.

Every year, just when you're trying to get used to new CPT Codes , the Correct Coding Initiative (CCI) comes along and limits how and when you can use the new codes you've been given. This year is no exception with CCI Edits 17.0 adding edits involving new Renessa and posterior tibial neurostimulator (PTNS) codes, among others.

The CCI released version 17.0, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, 2011 with CCI getting ready to halt payment if you report certain procedures together. Get a grip on the new bundles with this urology-focused rundown.

Skip Catheterization Coding With Renessa

CPT 2011 deleted Category III code 0193T (Transurethral, radiofrequency microremodeling of the female bladder neck and proximal urethra for stress urinary incontinence), replacing it with a new Category I code 53860 with the same descriptor. CCI targets 53860 with several edits.

When your urologist performs the Renessa procedure, you'll report 53860, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

As of Jan. 1, when 53860 became an active code, CCI 17.0 created edit pairs with the following column 2 codes that Medicare considers usual and necessary parts of any surgery:

• Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400- 36440, 36600-36640, and 37202
• Naso- or oro-gastric tube placement (43752)
• Bladder catheterization (51701-51703).

"In general CPT code 53680 would include catheter placement for temporary postoperative urinary drainage at the conclusion of the procedure, and therefore, these latter codes (51701 to 51703), should not be billed separately," Ferragamo says.

All of these edits carry a modifier indicator of "1," which means you can bypass the edits in some clinical circumstances, using a modifier such as 59 (Distinct procedural service).

Additionally: The Renessa procedure also bundles neurological codes 62310-62319 and 64400-64530. These edits have a modifier indicator of "0," meaning that you can never bypass these edits with any modifier.

Watch Out For Several New PTNS Bundles

CCI 17.0 also ties your hands when you report another new 2011 Category I code: posterior tibial neurostimulator (PTNS) code 64566 (Posterior tibial neurostimulator percutaneous needle electrode, single treatment, including programming).

Column one code 64555 (Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve]) " which you'll no longer use for PTNS coding - bundles column two code 64566 with a modifier indicator of "1." "Therefore, one should not bill 64566 in conjunction with 64555," Ferragamo says.

CCI also bundles the neurostimulator analysis programming column two codes 95970-95972 (Electronic analysis of implanted neurostimulator pulse generator system ...) and injection and infusion codes 96369, 96365, 96372, 96374, 96375, and 96376 into 64566. These edits have a modifier indicator of "1" as well.

Skip moderate sedation: Column 1 code 64566 also bundles column 2 codes for moderate (conscious) sedation: 99148-99150. These edits have a modifier indicator of "0."

You'll also find that column 1 code 64566 bundles the following column 2 codes:

• Venipuncture, IV, infusion, or arterial puncture services represented by codes 36000, 36400-36410, 36440, 36600-36640, and 37202
• Naso- or oro-gastric tube placement (43752)
• Bladder catheterization (51701-51703).

These edits have a modifier indicator of "1." So you can break the bundles if clinical circumstances warrant separate reporting.

Example: A patient has an office PTNS procedure in the morning and later that day returns to the office in acute urinary retention. The urologist places an indwelling Foley catheter, and the instructs the patient to return to the office the next morning. Report 64566 for the PTNS procedure and code 51702 for the placement of the Foley catheter. You'll add modifier 59 51702 to bypass the bundle and allow payment for the second service performed on the same day but at a separate office encounter.

Don't miss: CCI also bundles column 2 codes 62310-62319 and nerve block codes 64400-64450, 64483-66493, and 64510-64530 into 64566. These edits have a modifier indicator of "0," Ferragamo warns.

Also note that CCI 17.0 bundles column one code 64566 and column two codes 76000-76001 (Fluoroscopy ...), 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation), and 76998 (Ultrasonic guidance, intraoperative). However, these edits have a modifier indicator of "1."

Avoid 55876 With +49237

CCI 17.0 makes column 1 code 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], percutaneous, prostate, single or multiple), mutually exclusive with the 2011 add-on code + 49327 (Laparoscopic surgical; with placement of interstitial devices for radiation therapy guidance [eg fiducial markers, dosimeter], intraabdominal, intra-pelvic, and/or retroperitoneum including imaging guidance, if performed, single or multiple [List separately in addition to code for primary procedures]). This edit has a modifier indicator of " 0."

"When indicated you will use + 49327 in conjunction with laparoscopic abdominal, pelvic, or retroperitoneal procedure(s) performed concurrently," Ferragamo explains.

Update Your Radiology and Debridement Rules

You'll face several new fluoroscopy bundles this quarter. CCI 17.0 bundles fluoroscopy codes 76000 and 76001 into percutaneous renal biopsy (50021), percutaneous nephrostomy (50392), and ureteral manometric pressure studies (50396).

Additionally, don't report +77001 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [List separately in addition to code for primary procedure]) with 50021 (Drainage of perirenal or renal abscess; percutaneous) or kidney procedures in the range 50080-50398. CCI also bundles +77001 and 77002 (Fluoroscopic guidance for needle placement [eg, biopsy, aspiration, injection, localization device]) into laparoscopic kidney procedures in the 50542- 52700 range. All of the above edits have a modifier indicator of "1."

Watch ultrasound bundles, too: CCI 17.0 adds bundles between 50542 (Laparoscopy, surgical; ablation of renal mass lesion(s), including intra-operative ultrasound guidance and monitoring, when performed) and ultrasonic guidance code 76942 and intra-operative ultrasonic guidance code 76998.

Debridement: Not all news coming out of the new edition of CCI is bad. Effective Jan. 1 you'll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly revised debridement codes 11042-11044. In the past, if your practitioner performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services.

The majority of the new CCI edits take effect on Jan. 1, although some were published with retroactive dates. For more information on CCI edits, visit www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.