Urology Coding Alert

Plus: You also aren’t able to report moderate sedation separately.

The most recent version of National Correct Coding Initiative (NCCI) edits went into effect Jan. 1, 2017, with nearly 100,000 new additions. Twelve codes are listed as Column 2 components of virtually every procedure your urologist probably performs, so it’s time to acquaint yourself with these new pairings and learn how to report them.

Think of Epidurals as Secondary

Eight of the twelve Column 2 codes represent the newly introduced codes for epidural administration:

• 62320 – Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62321 – … with imaging guidance (i.e., fluoroscopy or CT)
• 62322 – Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62323 – … with imaging guidance (i.e., fluoroscopy or CT)
• 62324 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62325 – … with imaging guidance (i.e., fluoroscopy or CT)
• 62326 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
• 62327 – … with imaging guidance (i.e., fluoroscopy or CT).

The edits apply to urinary system procedures (50010-53899) as well as male genital system procedures (54000-55899).

“Seeing so many codes bundled with epidurals really isn’t a surprise since that’s how it was with the previous epidural codes,” says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Each of the edit pairs is assigned a modifier indicator of “0,” meaning you cannot break the edit or report both codes at a single patient encounter, no matter the clinical circumstances. The urology procedures are all in Column 1, so they are the correct codes of the pair to bill. No modifiers will allow payment of both codes.

Moderate Sedation Also Takes a Back Seat

CPT^® introduced new moderate sedation codes for 2017. Three are included in the edits with urology procedures:

• 99155 – Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 99156 – … initial 15 minutes of intraservice time, patient age 5 years or older
• + 99157 – … each additional 15 minutes intraservice time (List separately in addition to code for primary service). The plus sign associated with this code indicates that this is an “add-on” code to be billed in conjunction with 99155 and 99156 and without modifier 51 (Multiple procedures).

As with the edits involving urology procedures and epidurals, the moderate sedation edits apply to virtually every urology procedure your physician might perform. The edit pairs also have a modifier indicator of “0.” Because of this, you should only bill the urological code.

Watch for Your Single Exception

New 2017 CPT^® code 96377 (Application of on-body injector [includes cannula insertion] for timed subcutaneous injection) is also part of the group being paired with all the urology procedures.

Edits with code 96377 are the only pairs with a modifier indicator of “1.” Because of that, you might sometimes be able to “break” the bundle and report both codes – in special circumstances and with sufficient supporting documentation. For example, you might be able to report both codes from the pair when the procedures are performed on the same day but at different encounters, according to Michael A. Ferragamo MD, FACS, assistant clinical professor of urology with the State University of New York, University Hospital and Medical School at Stony Brook.

Code 96377 is new for CPT^® 2017. During the procedure, the provider fills a specially developed injector device with medication and applies the attached patch to the skin of a patient. When the injector is activated, it automatically inserts a cannula under the skin (subcutaneously) to deliver medication at specified timed intervals. An on–body injector permits various quantities of medications to be delivered in increments at specific timed intervals.

Important: Some payers may consider this procedure and/or the device investigational, so check with the payer regarding their policies. Regardless of coverage, the procedure should still be reported for tracking and statistical purposes when performed.

Final note: This edition of CCI includes thousands of deleted edits, but don’t let that get your hopes up for recouping fees from years past. Any pairs that pertain to urology include a code that’s no longer valid. For example, the previous edits involving 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) are deleted since 62310 has been deleted from CPT^®.