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 [...]