Urology Coding Alert

Pay attention to the modifier indicator to determine which ones you can override and which you can’t.

Every new year brings new, altered, and deleted codes that you must learn in order to keep your urologist’s reimbursement rolling in. And, on the heels of the code changes, the Correct Coding Initiative (CCI) adds to your learning curve by implementing a slew of new bundles.

CCI 19.0, which took effect on January 1, 2013, adds 37,587 new bundles and deletes 16, 716. Not surprisingly, many of the new CCI edits target new 2013 CPT^® codes, and urology wasn’t spared any changes. Read on to find out which CCI changes might affect your coding.

Avoid 52281 With Chemodenervation of Bladder

You will find new Botox bladder injection CPT^® code 52287 (Cystourethroscopy with injection[s] for chemodenervation of the bladder) bundled into column 1 code 52281 (Cystourethroscopy and urethral calibration/dilation). This edit pair has a modifier indicator of "0." That means you cannot undo the bundle with any modifier. In other words, "these two procedures can never be reported or reimbursed if performed at the same operative encounter or even on the same day but at different sessions," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.

Additionally: CCI 19.0 also bundles the following column 2 codes into 52287:

Anesthesia 00910 and 00916

Category III codes 0213T, 0216T, and 0230T

Wound closure codes 12001-12053

Intravenous codes 36000, 36405, 36410, 36420-36430, 36600, 36640

Catheterization codes 51701-51703

Cystoscopic codes 52000, 52001, 52310, 52315

Urethrotomy and meatotomy codes 53000-53025

Urethral dilation codes 53600-53665,

Pelvic exam under anesthesia code 57410.

"You’ll find 52287 bundles many other codes found in the neurological and medical sections which are rarely if ever coded by the urologist," Ferragamo adds. 

All of these noted edit pairs have a modifier indicator of "0," except the wound closure codes, intravenous and venous codes, and 52001 (Cystourethroscopy and evacuation of multiple obstructing clots), which all have a modifier indicator of "1." That means that you can use a modifier to override the bundling under specific clinical circumstances.

Get to know 52287: Remember that 52287 is a new code for 2013. Urology coding experts have said you should now use this code when your urologist performs Botox injections into the bladder detrusor muscle. Previously, you had no specific CPT^® code for Botox bladder injection procedures. Medicare and many other private and commercial carriers had suggested using 53899 (Unlisted procedure, urinary system) for the cystoscopy and bladder wall injections. Now you will use 52287 instead.

Count Nephrostogram as Part of Tube Change

CCI 19.0 bundles nephrostomy tube change code 50398 (Change of nephrostomy or pyelostomy tube) with nephrostogram code 50394 (Performance of a nephrostogram). This edit has a modifier indicator of "1."

"If the nephrostomy tube change occurs in a patient without new symptoms related to the tube, CPT^® code 50394 should not be reported separately for the tube check," Ferragamo says.

Pay Attention to These Lesser Used Codes, Too

While you may not often use the following codes, there is a chance your urologist will perform the procedures, and you’ll need to know the related CCI bundles.

Column 1 codes 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) bundle new 2013 column 2 nerve conduction test codes 95907-95913 and 95940. These edits carry a modifier indicator of "1."

Column 1 urological surgery codes 50220, 50225, 50230, 50234, 50236, and 50240 bundle column 2 codes 32556 (Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance) and 32557 (…with imaging guidance). These edits have a modifier indicator of "1" as well, "indicating that if pleural drainage is needed later on the same day of surgery after a radical nephrectomy, 50230, with pleural injury and intra-thoracic fluid accumulation, this service may be coded by appending modifier 59 (Distinct procedural service) to CPT^® codes 32556 or 32557 to bypass the edit," Ferragamo says.