Urology Coding Alert
Ureterolysis Gets Bundled
Time to get out your trusty red pen: The Correct Coding Initiative 8.2 edits have arrived, and the most recent changes to CPT Codes 2002 coding took effect July 1.
Unlike the CCI edits 8.0, the latest additions to urology coding policy are nearly equally divided between those codes that can be unbundled by modifiers under the proper circumstances and with supporting documentation, and those codes that can under no circumstances be unbundled.
A noteworthy CCI 8.2 edit is the bundling of the ureterolysis code. "Ureterolysis, 50715 the freeing of the ureter in the retroperitoneal space has been bundled into many urological and general surgical codes," says Michael A. Ferragamo, MD, FACS, assistant clinical professor of urology at State University of New York, Stony Brook.
The list of codes that now include 50715 consists of the following: 49200-49201, excision/destruction of retroperitoneal tumors; 50400-50405, pyeloplasty; 50605, ureterotomy; 50610-50630, ureterolithotomy; 50650-50660, ureterectomy; 50684-50690, ureter injection/test procedures; 50722-50725, ureterolysis; 50727-50728, revision of urinary-cutaneous anastomosis; 50780-50785, ureteroneocystostomy; 50800-50860, ureter/intestine procedures; 50920-50940, fistula closure/repair; 50945-50948, laparoscopic ureterolithotomy; 50955-50961, ureteroscopy through ureterostomy; 50974-50980, ureteroscopy through ureterotomy; 51000-51080, cystotomy; 51500-51597, cystectomy; 51600-51720, bladder injection/instillation; 51725-51797, urodynamics; 51800-51980, bladder repairs; 51990-51992, laparoscopic urethral suspension; 52260, cystourethroscopy with dilation of bladder for interstitial cystitis; 52310-52315, cystourethroscopy with removal of foreign body; and 52320-52346, cystourethroscopy for stones/strictures.
Other new comprehensive/component codes that can be unbundled:
is now included in 52005-52700, cystourethro-scopy procedures; and 53850-53853, other prostate procedures.
is now included in 53446-53448, sphincter removal/replacement procedures
Don't Come Apart Over Abundant Bundling
The new bundles don't come as a shock to Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services.
CCI's new bundles won't significantly affect most urology practices, Page says: "The edits are logical and to be expected. I see them as refinements and not surprises."
The new CCI edits also bring a number of bundles that can't be unbundled by modifier use. As of July 1, there are no circumstances under which microsurgery, 69990, can be billed separately from the following codes: 47370-47371, laparoscopic ablation of liver tumors; 47380-47381, open radiofrequency ablation (RFA) of liver tumors; 49491-49492, preemie inguinal hernia repair; 53446/53448, removal/replacement of inflatable sphincter; 53853, WIT procedure; 54162-54164, circumcision, lysis and frenulotomy codes; and 54411/54417, removal and replacement of penile prosthesis through infected field.
The remaining new bundles that can't be unbundled include:
The new edits brought only three additions of mutually exclusive codes to urology coding practice. The first states that "adult" hernia repair codes, 49505-49525, are mutually exclusive to the preemie codes, 49491-49496. These mutually exclusive hernia codes do allow for some unbundling.
In contrast, the second and third new sets of mutually exclusive codes do not allow for any unbundling. WIT procedure, 53853 (Transurethral destruction of prostate tissue; by water-induced thermotherapy), is now mutually exclusive to TUMT, 53850 ( by microwave thermotherapy); TUNA, 53852 ( by radiofrequency thermotherapy); and cryosurgical ablation of the prostate, 55873.
Code Reunion CCI 8.2
With the latest CCI deletion edits, a few formerly isolated urology codes are being reunited with ex-partners. On July 1, these formerly mutually exclusive codes will be once again on the market for pairing:
"However, under proper clinical circumstances ureterolysis code 50715 may be unbundled with modifiers -58, -59, -78 and -79," Ferragamo adds.
Page asserts that the changes generally follow CPT coding guidelines. For example, the inclusion of ureterolysis, 50715, in most genitourinary procedures is in accordance with CPT guidelines that state lysing of adhesions, unless extensive, is included in the surgical approach. "Another example would be a diagnostic cysto. As with other endoscopy procedures, a surgical endoscopy includes a diagnostic endoscopy," Page says.
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