Urology Coding Alert

CMS offers clear guidance on what to include in pelvic exenteration coding.

Although coders mostly think about the quarterly lists of coding bundles when it comes to the Correct Coding Initiative ( CCI ), there is another side to national bundling rules -- the National Correct Coding Initiative Policy Manual. And thanks to a Jan. 2012 update, you should peruse the manual to determine what's changed this year.

We have the lowdown on a few important changes that are sure to affect the way you code your services, thanks to coder Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding, and senior coder and auditor with The Coding Network, who broke down the changes.

Background: The Policy Manual is updated annually and offers the rationale for various CCI edits. To read the complete updated Policy Manual, visit www.cms.gov/NationalCorrectCodInitEd.

Pay Attention to Pelvic Exenteration Changes

If your urologist performs a complete pelvic exenteration procedure, including all the pelvic organs such as the urinary bladder and the prostate gland, you should not separately code for the individual removal of these organs. This new guidance is found in the Jan. 2012 update to the Policy Manual.

How it works: When you report a pelvic exenteration, there are several CPT^® codes from which you may choose, depending on the type of malignancy involved, as followed:

45126 -- Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), or any combination thereof

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

58240 -- Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof.

Official wording: The following text appears in the urinary system and female genital system sections of the Policy Manual: "Pelvic exenteration procedures (CPT codes 45126, 51597, 58240) include extensive removal of structures from the pelvis. Physicians should not separately report codes for the removal of pelvic structures (e.g., colon, rectum, urinary bladder, uterine body and/or cervix, fallopian tubes, ovaries, lymph nodes, prostate gland)."

CMS Discusses MUE Value of '0'

Medically unlikely edits (MUEs) are still relatively new, so many coders might scratch their heads at some aspects of these edits--particularly when a service has a limit of '0.' If you're wondering why a service would be listed at all if the limit is zero, the 2012 update to the manual finally offers some answers.

"The rationale for such values include but are not limited to: discontinued manufacture of drug, non-FDA approved compounded drug, practitioner MUE values for oral anti-neoplastic, oral anti-emetic, and oral immune suppressive drugs which should be billed to the DME MACs, and outpatient hospital MUE values for inhalation drugs which should be billed to the DME MACs," the manual notes.

In other words, CMS wants the code listed in the CCI edits, but wants to remind coders that it won't be reimbursed.