Urology Coding Alert

The latest version of the national Correct Coding Initiative (CCI), effective Oct. 1 to Dec. 30, 2002, can be summed up as one small step for coders, one giant leap for CMS' standard of care. CMS reasons that once a "lesser" procedure is a regular and generally accepted part of a more extensive procedure it becomes the standard of care and is therefore incidental and not separately payable.

Version 8.3 of the CCI edits has the bundles to prove that CMS considers many injections, infusions, catheterizations and imaging procedures incidental to the vast majority of surgical specialty procedures (see "Bundles Barely Budge Urology Coding Practices" article # 3). These edits shouldn't have much of an effect on Urology Coding , according to Robert Smith, MD, a urologist with Urology Associates in Red Bank, N.J. The coding specialist for Urology Associates, Trudy Bouldin, agrees: "The bundling of the infusions and injections seems much more applicable to hospital urology coding" and other inpatient facilities than for office coding practices.

But there are new urology-specific comprehensive and component code pairs that will affect urology coding, including the bundling of the evacuation of clots into the anti-incontinence procedures. Beginning Oct. 1, code 52001 (Cystourethroscopy with irrigation and evacuation of clots) is bundled into 51840 (Anterior vesico-urethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple), 51841 ( complicated [e.g., secondary repair]) and 51845 (Abdomino-vaginal vesical neck suspension, with or without endoscopic control [e.g., Stamey, Raz, modified Pereyra]). In the past, if the urologist passed a needle through the bladder during a sling procedure causing a hematuria and clots, both the sling procedure and the clot aspiration might have been billed separately, Smith says. But now the clot aspiration is considered, understandably, "part of the incontinence procedure," he says. Also, if a physician performs evacuation of clots (52001), he can no longer bill for urethral dilation, 53600-53661, nor can he bill for the urethral catheter insertion, 53670* (Catheterization, urethra; simple) and 53675* ( complicated [may include difficult removal of balloon catheter]).

"If you are aspirating a few clots out of the catheter you have placed, the bundle makes sense because it is part of the procedure," Smith says. "But if you had to go to the operating room to pass the cystoscope to aspirate clots, I would expect that you could bill separately for it." Smith cites an example of a patient presenting with bleeding, gross hematuria, and clots formed in the bladder that block the urethra, prohibiting urination. The urologist has to pass a catheter to drain the bladder, but if the clots are severe he may have to place a bigger catheter to aspirate the clots, which, in his opinion, should be considered a separate [...]