Urology Coding Alert

Tip: You can override the new edits with a modifier in certain circumstances. 

If your urologist performs abdominal paracentesis or peritoneal lavage, you’ll have trouble reporting 49082-40984 with many laparoscopic and robotic urological surgery codes, thanks to Correct Coding Initiative (CCI) version 19.1. CCI 19.1 took effect on April 1, 2013.

Good news: There are not many edits to worry about this time around. “This is probably the smallest impact I have seen since the beginning of the program,” said Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. “There are 744 new edit pairs and only 32 terminated edit pairs.”

Urology Coding Alert’s experts have reviewed the changes and determined which ones your urology practice needs to know. Read on to learn the details.

Learn the New 49082-49084 Rules

Per CCI 19.1, codes 49082 (Abdominal paracentesis [diagnostic or therapeutic]; without imaging guidance), 49083 (... with imaging guidance), and 49084 (Peritoneal lavage, including imaging guidance, when performed) are now bundled into urological laparoscopic/robotic codes 50541-50548 (renal procedures), 50945-50948 (ureteral procedures), and 51990-51992 (urethral procedures).

“These codes (49802-49804) are also bundled into laparoscopic codes 54690-54692 (testicle), 55550 (... ligation of spermatic veins for varicocele), and 55866 (radical laparoscopic/robotic prostatectomy) as well as many laparoscopic general surgical and gynecological procedure codes,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.

These edits all have a modifier indicator of “1,” which means you can bypass the bundling under special clinical circumstances using a modifier, usually modifier 59 (Distinct procedural service). “The unbundled CPT codes will be paid along with the primary laparoscopic procedure,” Ferragamo explains.

In addition: Laparoscopic lymph nodes resection codes 38570-38572 (Laparoscopy, surgical; with retroperitoneal lymph node sampling [biopsy]) often used with major urological surgery procedures now bundle the abdominal paracentesis and lavage codes as well. These edits also have a modifier indicator of “1,” Ferragamo says.