Urology Coding Alert

Plus, you'll find 51597 bundles several procedures now as well.

Every year at this time you're faced with new and revised codes you need to learn and just when you think you have the changes mastered, the Correct Coding Initiative ( CCI ) comes along and throws coding restrictions at you.

The CCI released version 18.0 at the end of 2011, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now denying payment if you report certain procedures together. For instance, you'll find skin repair codes 12001-12021 bundled into new skin substitute grafting codes 15271-15278, but in most cases, a modifier can separate the edit.

Good news: There are not too many edits to learn and apply to your urology coding, even though this is the first round of bundling for 2012. Here are the ones you need to know.

Add Urethral Catheterization Bundles to Your CCI Lists

Thanks to CCI 18.0, you'll find the following urethral catheterizations codes bundled with column one codes 29582-29584 (Application of multi-layer compression system ...):

51701 -- Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)

51702 -- Insertion of temporary indwelling bladder catheter; simple (eg, Foley)

51703 -- ... complicated (eg, altered anatomy, fractured catheter/balloon).

"Therefore, as with so many other procedures, catheterization of the urinary bladder at the same time as a primary procedure should not constitute an additional charge," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

Silver lining:  These edits have a modifier indicator of "1." That means you can bypass the edit with a modifier under specific clinical circumstances, says Elizabeth Hollingshead, CPC, CUC, CMC, CMSCS, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. 

But remember: You cannot simply add a modifier (such as 59, Distinct procedural service) any time you want to separate a bundle like this -- you have to justify it with the physician's documentation. "It would be a separate site, different session, different organ system, separate lesion, or separate injury for use of the 59 modifier to unbundle wound closure services from skin substitute procedures," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding, and senior coder and auditor with The Coding Network. "Per the 59 modifier definition, these are the qualifications."

Watch These Urogynecology Edits

If your physician implants a biological implant, such as an acellular dermal matrix, you won't be able to report the new add on code +15777 (Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] [List separately in addition to code for primary procedure]) with any of the following codes when the procedures are performed at the same encounter:

57240 -- Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele

57250 -- Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy

57260 -- Combined anteroposterior colporrhaphy

57265 -- ... with enterocele repair

57285 -- Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach.

"However, remember, for the urologist or urogynecologist, for the insertion of mesh or other prosthesis for repair of pelvic floor defects, use add on CPT code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure])," says Ferragamo.

Additionally: You'll also find that CCI 18.0 bundles column two code 57283 (Mayo-McCall colpopexy, ...) with column one code 57556 (Excision of cervical stump, vaginal approach, with enterocele repair) with a modifier indicator of "0." "When performing both of these procedures, bill and code only for CPT code 57556," Ferragamo explains.

Avoid Paracentesis With Pelvic Exenteration, Too

CCI 18.0 also ties your hands when you urologist performs a complete pelvic exenteration and an abdominal paracentesis. Column one code 51597 (Pelvic exenteration, complete, for vesical, prostate, or urethral malignancy...) bundles new codes 49082-49084 (Abdominal paracentesis ...). These edits also have a modifier indicator of "1," Ferragamo says.

You will also find 95938 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs) bundled with 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) and 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique) under the newest CCI edits. These bundles also carry a modifier indicator of "1."