Urology Coding Alert

If you don't know the meaning of '0' modifier indicators, you're asking for denials.

The last round of Correct Coding Initiative ( CCI ) edits for 2011 target your meatotomy and urethrotomy coding. Your hands will be tied when your urologist performs those procedures with many other procedures, including endoscopic procedures such as transurethral resections of the prostate (TURPs).

CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. As was the case with the previous CCI edition, the majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT® manual.

Read on to find out which edits will affect your urology coding.

Skip 59 With 53000 and 53010 Bundles

If your urologist performs a penile or perineal urethrotomy or external meatotomy with any endoscopic procedure in the 52000-52700 range, you won't be able to separately report the service. CCI 17.3 bundles the following codes with 52000-52700:

• 53000 -- Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra
• 53010 -- Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external
• 53020 -- Meatotomy, cutting of meatus (separate procedure); except infant
• 53025 -- Meatotomy, cutting of meatus (separate procedure); infant.

Plus: You'll also find those four codes bundled with urethral and hypospadias repair codes 54300-54390 as well. Urethral dilations codes 53600-53665 will also bundle column two CPT codes 53000-53025. The following CPT column one codes bundle 53000-53025:

• 51715 -- Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck
• 51800 -- Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck
• 51820 -- Cystourethroplasty with unilateral or bilateral ureteroneocystostomy
• 51840 -- Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple
• 51841 -- ... complicated (eg, secondary repair).

No exceptions: All of these new bundling have a modifier indicator of "0," which means you can never separately report the services. In other words, you can never bypass these edits with any modifier, including modifier 59 (Distinct procedural service).

"This means meatotomies and urethrotomies will no longer be paid when billed with cystoscopic procedures such as 52601(TURP) and 52648 and 52649 (laser prostatectomies), which are often performed with the above to avoid urethral injury during these endoscopoic procedures" says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

Avoid Appendectomy Additions

CCI 17.3 bundles 44970 (Laparoscopy, surgical, appendectomy) into a large number of column one urological codes including the following:

• 50010-50075
• 50100-50220
• 50340-50380
• 50400-50540
• 51020-51597
• 55801-55865.

"Many gynecological and urogynecological procedures -- column one codes 57106-57335 -- also bundle laparoscopic appendectomy, 44970," Ferragamo says. You cannot break the bundles because they all carry a modifier indicator of "0."

Additionally: Laparoscopic renal procedures (50541-50548), radical prostatectomy (55866), urethral procedures (51990-51992), testicular procedures (54690-54692), and spermatic vein ligation (55550) all bundle column two code 44950 (Appendectomy). These edits also have a modifier indicator of "0."