Urology Coding Alert

Discover how modifier 59 can help you overcome these new bundles

The Correct Coding Initiative (CCI) version 14.2, effective July 1, targets several urology-related CPT Codes with new CCI Edits -- and it's your job to make sure those edits make it into your coding process. Here's the rundown of the latest bundles you need to know.

In a nutshell: CCI bundles most of the ureteral repair codes (50700-50840) with each other as mutually exclusive procedure codes. These edits make sense because a urologist would rarely perform multiple ureteral repairs during the same procedure, experts say.

Avoid Overusing Modifier 59

Good news: All of the new ureteral repair code edits have a modifier indicator of "1." This means that you can unbundle these edits with the proper modifier under the appropriate clinical circumstances.

Although you can bypass many of the bundles with modifier 59 (Distinct pro-cedural service), you must meet the criteria for doing so, says Debra Pierce, MD, MBA, CPC, founder and managing member of Pierce MD Consulting LLC in Rockbridge, Ohio. CPT 2008 revised the modifier's descriptor, specifying, "Documentation must support:

• different session

• different procedure or surgery

• different site or organ system

• separate incision or excision

• separate lesion

• separate injury (or area of injury in extensive injuries)."

Caution: "CMS has improper use of modifier 59 on its radar screen and practices are well-advised to exercise due caution in using this modifier," Pierce warns.

Remember: Although you can bypass many of the bundles using modifier 59, this is the modifier of last resort. CPT warns that you should not use modifier 59 "when another already established modifier is appropriate, unless no more descriptive modifier is available, and so long as it best explains the circumstances," Pierce says.

Home In on New 52353 Edit

CCI 14.2 also adds a bundle reversal for 50590 (Lithotripsy, extracorporeal shock wave) and 52353 (Cystourethroscopy, with ureteroscopy and/or pye-loscopy; with lithotripsy [ ureteral catheterization is included]). The latest round of edits deletes the bundle tying 50590 into 52353. Now CCI bundles 52353 into CPT code 50590. In other words, CCI reversed the bundle.

Reasoning: The problem was that 50590 pays more than 52353, experts say. This switch makes the bundle more logical because now the higher paying code bundles the lesser paying code.

Note: This new edit has a modifier indicator of "1," so you can override the bundle with the appropriate modifier.

Tip: When the clinical circumstance you're coding warrants modifier 59, make sure you append it to the appropriate code from the CCI bundle, Pierce adds. For example, in the case of the new 50590/52353 bundle, you need to put the modifier on 52353 since you should append the modifier to a bundle's column 2 code.

Kiss Troublesome Urogyn Bundles Goodbye

Urogynecologists have been struggling for more than five years with a particular set of CCI edits. But as of July 1, CCI deletes those edits retroactive to January of this year.

If you were anguished over the years-old edits that bundled 57287 (Removal or revision of sling for stress incontinence [e.g., fascia or synthetic]) and 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) into 57284 (Paravaginal defect repair [including repair of cystocele, if performed]; open abdominal approach), you won't have to give up reimbursement anymore.

"Providers may hold their claims for the 57287 and 57288 services which would be denied if the NCCI edits were applied, and resubmit these claims after the correction is implemented on July 1, 2008," according to the April 2008 American College of Obstetrics and Gynecology Coding and Practice Management Update.

Old way: The 57287 bundle was "never an onerous bundle to begin with as it carried a '1' indicator," says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. "If a sling was removed it could be billed with a modifier 59, as the removal of a sling for stress urinary incontinence would not be related to a paravaginal repair in the first place and the surgery would qualify under 'separate incision/excision.'"

New way: You will now be able to report 57284 as a primary procedure and then 57288 or 57287 as secondary procedures without having to add a modifier.