Urology Coding Alert

But stop unbundling scrotal exploration and orchiectomy,CCI says

You'll have to alter some of your cystourethroscopy and scrotal procedure coding this quarter, thanks to Correct Coding Initiative (CCI) version 14.3, which took effect on Oct. 1.

What you need to know: Among other changes, CCI Edits 14.3 changes the modifier indicators for several coding bundles, allowing you to now report some codes together using a modifier, but at the same time, taking away the overriding ability with other code bundles. Here's the lowdown on the latest changes affecting your urology coding.

Persistence Pays Off

Coders have been struggling with the bundle between 52352 (Cystourethroscopy,with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus ...) and 52353 (... with lithotripsy [ureteral catheterization is included]). The good news is that CCI finally listened. Effective Oct. 1, 52352 continues to be bundled into 52353; however, this edit's indicator changed from a "0" to a "1," meaning you can bypass this edit with a modifier.

Problem: "I had been working on the unbundling of separate, unequal ureteroscopic procedures for some time," says Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind. "I was tired of writing off work on one ureter when a different procedure was performed on the contralateral ureter. The RVUs [relative value units] for each ureteroscopy procedure are for a single ureter only; however, since cystoscopy is a necessary component of all of these codes and the bladder is a solitary organ rather than a paired organ], Medicare paid nothing for the work performed via ureteroscopy for the second procedure [on the contralateral ureter]."

New way: The modifier you'll most often use to break the bundle is modifier 59 (Distinct procedural service). Append modifier 59 to 52352 if your urologist performs the cystourethroscopy and lithotripsy procedure (52353) on one side of the upper urinary tract, and cystourethroscopy and ureteroscopic stone manipulation or extraction 52352) on the opposite side -- in other words, if the physician performs the procedures bilaterally on both ureters or kidneys, during the same session.This change will have a positive impact for urology coders, says Laura Cwiklinski, office manager at Urology Partners Inc. in Cleveland. "The billing of 52352 and 52353 with a modifier 59 will increase revenue for your practice," she adds. "This has been lost income to urologists for some time."

The breakdown: When the physician's documentation supports reporting both 52353 (11.91 RVUs) and 52352-59 (10.34 RVUs), you will now earn an additional $393 10.34 multiplied by the 2008 conversion factor of 38.0870, unadjusted national rate) because you can now additionally report 52352.

Note: CPT and the American Urological Association (AUA) have indicated that you should only unbundle these codes when the stones are located bilaterally in the urinary system. The use of modifier 59 to break the edit on same-sided stones, whether ureteral or kidney, will have to await further coding changes from CPT and the AUA. At present, only bypass this edit when treating bilaterally occurring stones.

"I, personally, was hoping for a little more, but now, at least for these two codes, my physicians will get paid for the work they do," Kater adds.

Scrotal Exploration Undergoes Changes

CCI 14.3 hits scrotal exploration code 55110 (Scrotal exploration) hard. This procedure is now bundled into nearly 30 other codes, including orchiectomy codes 54522-54535, and testicular repair codes 54600-54692.

No breaking: The modifier indicator for these new bundles is "0." Therefore, you cannot use a modifier to separate these edits.

Why: "It makes sense to me," Kater says. "In essence, you are accessing the problem -- though when you start the exploration you're not always sure of the exact problem. The exploration then becomes integral to the more precise procedure."

Downside: These new bundles will have a negative effect in coding for your practice, Cwiklinski says. "Not being able to separate scrotal exploration with a modifier will hinder the billing of orchiectomy codes 54522-54535 and testicular repair codes 54600-54692 and will result in a loss of income," she explains. "I feel they are trying to stop the abuse of coding scrotal exploration unnecessarily.But not allowing the modifiers to be used in billing situations where true scrotal explorations are needed to support and make medical decisions for the patient is a negative for the urologist."

In addition: CCI also bundles 55110 into 54520 (Orchiectomy,simple [including subcapsular], with or without testicular prosthesis, scrotal or inguinal approach) and 55100 (Drainage of scrotal wall abscess). In version 14.3, the modi-fier indicator for these two edit pairs is changed from "1" to a "0," indicating that you can no longer bypass this edit with any modifier.