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Urology Coding Alert

CCI Bundles Foreign-Body Removal into Cystoscopy

Published on Thu Nov 01, 2001

The stent coding dilemma has been resolved with CCI  version 7.3, effective Oct. 1, 2001, through Jan. 1, 2002. Removal has finally been bundled into insertion. No modifier can override this bundle. CCI assumes that if you insert the stent, you will, at some time, have to remove it.
 
It's a logical edit which many commercial payers have already put in place. Because the stent codes (52310, 52315) are the same codes used for foreign body removal, the entire series of cystoscopy codes is included in the bundle. There is an exception for litholapaxy, however, in which the foreign-body (stone or fragments) removal could be billed as well as the litholapaxy itself.      

Stents

Foreign-body removal, which includes stent removal, has been bundled into cystoscopy codes 52005-52400. The two codes that have been bundled are 52310 (cystoure-throscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) and 52315 ( complicated). This means that stent removal is bundled into 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type) and is not separately payable. To bill stent exchange, use only 52332. Many commercial carriers have followed this edit for some time.
 
The litholapaxy exemption: Cystoscopic extraction of bladder calculi (52310 and 52315) with cystoscopic lithotripsy (52317- litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm] and 52318 complicated or large [over 2.5 cm]) are no longer payable as separate services. However, the litholapaxy codes have a modifier indicator of  "1," indicating that the edits can be overridden with an appropriate modifier under the appropriate clinical circumstances. All other edits within the 52005-52400 group of codes have a modifier indicator of "0"; unbundling is never allowed.
 
Typically, following litholapaxy, the physician removes stone fragments from the bladder either by irrigation using an ELLIK evacuator or by cystoscopic extraction with a grasping forceps. According to the latest CCI edits , urologists can no longer bill for the extraction (52310, 52315) when performing litholapaxy (52317, 52318). "CCI now says that if you break up the stones and have to remove them with a grasping forceps, the latter is an integral part of the surgery," says Michael A. Ferragamo, MD, assistant clinical professor of urology at the State University of New York, Stony Brook. Therefore bill only 52317 or 52318.
 
However, there are certain circumstances in which both the litholapaxy and the foreign body (stone) removal can be billed. For example, following litholapaxy, but at the same session, the urologist must remove the majority of the stone fragments with the grasping forceps. If this takes a lot of time and work, code 52310 or 52315, and append modifier -59 to the code, Ferragamo says. The modifier -59 will override the edit, allowing payment of both procedures (52317 or 52318, and 52310 or 52315). "Clearly document this part of the procedure," Ferragamo says.
 
If the stone fragment doesn't require removal until the next day however, code 52317 again; litholapaxy has a 0-day global.

Urethral Dilation

Urethral dilation codes 53600, 53601, 53605, 53620 and 53621 are bundled into a range of cystoscopy codes, with a modifier indicator of "0" meaning unbundling is never allowed. Urethral dilation is now included in such procedures as transurethral resection of the prostate (52601, 52606, 52612, 52614, 52620 and 52640). Dilation represents an integral part of the comprehensive procedure.

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