Urology Coding Alert

Watch out for 'standards of surgical practice' edits surrounding 55706.

If your urologist performs cystectomies or prostate biopsies, take note. The Correct Coding Initiative ( CCI ) takes aim at 51565 (Cystectomy, partial, with reimplantation of ureter[s] into bladder [ureteroneocystostomy]) and CPT 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance).

CCI released version 17.1 last month, revealing 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March statement. That's a large number of new edit pairs for the second quarter, which typically slackens after adding many new-code pairs in the first quarter.

"There are several bundled edits found in the recent Correct Coding Initiative, version 17.1 for urological services," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

Save time and the headache of scanning thousands of lines in a spreadsheet by reviewing this rundown of edits you need to know for urology.

Count Partial Cystectomy in 51565

CCI 17.1 bundles column 2 codes 51550 (Cystectomy, partial, simple) and 51555 (Cystectomy, partial, complicated [eg. postradiaion, previous surgery, difficult location]) with column 1 code 51565.

Beware: These edits have a modifier indicator of "0," meaning that you can never bill these latter codes with 51565.

"If you do a partial cystectomy with ureteral reimplantation, you cannot also bill separately for a partial cystectomy," Ferragamo says. "It makes sense really."

Include Standard Surgical Services With Biopsies

Medicare specifies that when you bill a surgical code, the procedure includes all intraoperative services that are usual and necessary parts of the surgery. That's why CCI 17.1 lists "standards of medical/surgical practice," as the reason for more than 2000 new code pairs.

Column 2: CCI 17.1 bundles the following column 2 codes with prostate biopsy code 55706. Medicare considers the procedures usual and necessary parts of surgery:

The code bundles in the first two bullets carry a modifier indicator of "1," which means that you can override the edits using a modifier such as 59 (Distinct procedural service) if clinical circumstances warrant. The ECG, EEG, and respiratory services bundles have a "0" modifier indicator, however.

Watch nerve blocks, too: CCI 17.1 bundles many column 2 nerve-block codes in the range 62310-64530 with 55706. CMS designates these "misuse of column 2 code with column 1 code," and assigns a "0" modifier indictor.

"That means you can never override these edit pairs that bundle many surgical procedures with somatic, autonomic or epidural nerve blocks," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle. "These edits may be targeting the use of blocks for post-op pain management by the surgeon, since Medicare bundles those services," she says.

Inguinal Hernia/Spermatic Cord Repair Make 1 Procedure

Be careful when your urologist works with a general surgeon who performs a laparoscopic inguinal hernia repair with other procedures in the same region. CCI 17.1 bundles the service (49650-49651, Laparoscopy, surgical; repair ... inguinal hernia) with the following column 2 codes: