Urology Coding Alert

Don’t forget to check the deletions as well.

The last round of Correct Coding Initiative (CCI) edits for 2013 brings 1276 new edits. The good news is only a few apply to your urology practice.

“CCI version 19.3, effective October 1 of this year, has been released and contains some real surprises,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla.

Read on to learn which edits you need to take note of to ensure your urology practice does not fall victim to denials during the last quarter of 2013.

Avoid 57410 With 49203-49205

CCI 19.3 bundles open excision of abdominal and retroperitoneal tumors — codes 49203-49205 (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas ...) — with the following column two codes:

• 57410 — Pelvic examination under anesthesia (other than local)
• 50722 — Ureterolysis for ovarian vein syndrome
• 50725 — Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava.

The bundles between 49203-49205 and 57410 have a modifier indicator of “0,” meaning the edits can never be broken with any modifier.

The 49203-49205 bundling with 50722 and 50725, however, have a modifier indicator of “1.” This means that these edits can be broken with the proper modifier and under specific clinical circumstances, using a modifier such as modifier 59 (Distinct procedural service).

“Therefore, the abdominal and retroperitoneal surgical procedures include the ureterolysis, which should not be coded, billed, or paid when performed with these procedures at the same surgical session,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. 

 Tap Modifier 59 for New 52346 Bundles

You will also find column one codes 52352-52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy ...) now bundle column two code 52346 (Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture [eg, balloon dilation, laser, electrocautery, and incision]), courtesy of CCI 19.3. These edits have a modifier indicator of “1.”

“This means that if the urologist incises an intra-renal stricture and then removes, or fragments a calyceal calculus or treats a calyceal tumor, one should not code or bill for the intra-renal incision unless special circumstances exist,” Ferragamo says. “Under these circumstances, append modifier 59 to CPT^® code 52346.”

Don’t Forget to Update Your Deletions

CCI 19.3 doesn’t just include additional new bundles. You’ll also find several deletions of which your urology practice should take note.

“If you recall, the last release [CCI 19.2] contained almost 300,000 new code pairs,” Cohen explains. “Well, it seems that CMS had a change of heart on over 10,000 of those edit pairs and for the October 1 release, decided to remove them from the active pair list. But what is even more surprising is that, of the 10,580 edit pairs that were put into the terminated column, nearly all of them were terminated retroactive to July 1, 2013.”

What it means to you: “Well, if you decided not to bill for the code pair because it was on the active list, you didn’t get paid for something that should have been paid,” Cohen says. “And if you did bill for the prohibited code pair and were denied payment, then you also didn’t get paid for something that should have paid. Either way, this kind of mistake creates chaos and adds to the cost of the claims process.”

Urology specific: CCI 19.3 deletes the bundling edits of column one code for pelvic exenteration (51597, Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof) with column two codes for colonic conduit formation (50815, Ureterocolon conduit, including intestine anastomosis) and ileal conduit formation (50820, Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker operation]).

“Therefore, when performing a pelvic exenteration one may now bill for the type of urinary diversion (colonic conduit [50815] or an ileal conduit [50820]) used,” Ferragamo says.

 Additionally, you’ll find CCI 19.3 does away with the bundles between E/M codes 99201-99205, 99211-99214, 99217, and 99281-99283 with 99239 (Hospital discharge day management; more than 30 minutes). “Theses E/M services, if performed, may now be coded and billed with the above discharge summary code when occurring on the same day,” Ferragamo explains.