Urology Coding Alert

Review the record number of changes that hit CPT® codes on Oct. 1.

Every quarter coders wait with bated breath to see the effect the latest round of Correct Coding Initiative (CCI) will have on their coding. CCI 18.3 is a doozy.

"In the 15 years or so that I have been analyzing the NCCI database, this release will go down in history as the Ripley's Believe it or Not quarterly change," warns Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. "Effective October 1, 2012, there will be 233, 242 new edit pairs added to the database. So, in addition to the overwhelming volume of reasons that payers use to deny payment to a practice, you can add 1 million more, which is just about the size of the new NCCI database. Over 97 percent of these were surgical procedures (codes 10000 through 69999) and almost all fell within the policy statement of 'Misuse of Column 2 code with Column 1 code.'

"Adding insult to injury, there were 474 edit pairs where the modifier indicator was changed from '1' (you may be able to bypass the policy using a modifier) to '0' (modifiers are not permitted under any circumstance)," Cohen explains.

Good news: Not many of the thousands of changes will directly impact your urology coding. Our experts have combed the huge database so you don't have to. Read on to learn on which new code pairs you should focus.

Suture Repair Is a 'No-Go' With Integumentary Codes

Suture repair of skin incisions, punctures, or lacerations, including CPT® codes 12001 to 13153 are now bundled with most codes in the integumentary system (skin). For example, repair codes are now included in the following:

• 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) and 10061 (... complicated or multiple)
• 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) and 10121 (... complicated)
• 10180 to 19396 (many other integumentary procedure codes).

CCI 18.3 also bundles 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) into 11980 (Subcutaneous hormone pellet implantation [implantation of estradiol and/or testosterone pellets beneath the skin]).

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

Urologists report 11980 for the implantation of testoeterone pellets, and often use 12001 when the puncture site is specifically closed, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. "The above new bundling now will not allow billing for routine suturing of the puncture site with 12001when implanting the pellets," he explains. However, if your urologist at the conclusion of the implantation, sutures the skin puncture site to control excessive bleeding, report 12001 and append modifier 59 to bypass the CCI edit. This is permissible since this edit carries a modifier indicator of "1," and the suturing is a "distinct procedure" performed to control the bleeding.

Modifier 59 Is Key to Suture Plus Surgery Coding

Skin suture repair codes 12001 to 13153 are also included in all urological codes from 50010 to 55920, all gynecology codes 56405 to 55920, as well as all neurology codes. Of particular interest to urology are the bundling of 12001-13152 with the following codes from the neurological section:

• 64566 (Posterior tibial neurostimulation percutaneous needle electrode, single treatment, including programming), which urologists use for posterior tibial nerve stimulation (PTNS) therapy
• 64561 (Percutaneous implantation of neurostimulator electrode array; sacral nerve [transforaminal placement] including image guidance, if performed) and 64581-64595, all of which urologists perform with sacral nerve stimulation.

These pairings also have a modifier indicator of "1," so you can break the bundles under specific clinical scenarios. "Remember that these edits indicate that the surgical treatment of skin lesions or other procedures of the skin as well as surgical incisions of the skin always include suture repair of the operative site," Ferragamo explains.