Urology Coding Alert

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.

"However, under proper clinical circumstances ureterolysis code 50715 may be unbundled with modifiers -58, -59, -78 and -79," Ferragamo adds. Other new comprehensive/component codes that can be unbundled:   52001 cystourethroscopy with evacuation of clots   is now included in 52005-52700, cystourethro-scopy procedures; and 53850-53853, other prostate procedures.   53080 drainage of perineal urinary extravasation   is now included in 53446-53448, sphincter removal/replacement procedures   50398* nephrostomy/pyelostomy tube change now includes 76003, radiologic needle guidance via fluoroscopy; 76360, computerized axial tomographic guidance for tissue ablation (CT); 76393, magnetic resonance guidance for needle placement (MRI); and 76942, ultrasonic guidance for needle placement.   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."

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. The new CCI edits also bring a number of bundles [...]