Urology Coding Alert

You might not use the edits, but you’ll want to be aware.

With almost 22,000 new edits in the latest edition of Correct Coding Initiative (version 22.1), it’s not surprising to find more than 1,800 that apply to urology codes. The good news is that all the edits revolve around the same four Column 2 codes – but don’t get overconfident in assuming which urology codes are included.

Focus on IV Infusion Procedures

Every urology code from the CPT® range 50010-55899 that is part of CCI 22.1 is considered a Column 1 code for pairs with each of these procedures:

• +96361 – Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
• +96366 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
• +96367 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
• +96368 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure).

“These are all ‘add-on’ codes and cannot be billed alone,” points out Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook. “They must be billed with a primary code and, if the codes are bundled, billed with a modifier to break the bundle and be paid.”

As a Column 1 code, when you report a urology procedure such as 50405 (Pyeloplasty [Foley Y-pyeloplasty], plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated [congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty]) with one of the four add-on IV infusion codes above, append a modifier (such as modifier 59, Distinct procedural service) to the infusion code to insure payment.

Good news: Each edit pair carries a modifier indicator of “1,” meaning that you might be able to report both codes in an edit pair if you have sufficient documentation to support separate coding. If so, you should append a modifier (such as 59, Distinct procedural service) to the Column 2 code.  

“These edits will rarely affect urologists as the IV infusions are usually performed in a hospital setting by a nurse or other hospital employee for whom the hospital bills,” Dr. Ferragamo says. “However, it’s always a good idea to be aware of edits in the specialty even if you don’t think you’ll ever use them.”

Watch for Edit Exceptions

CCI 22.1 bundles the add-on IV infusion codes into virtually every urology procedure in CPT®, but you are able to still report some services without the stress of trying to override an edit. The following procedures can be submitted with the IV infusion codes and no special documentation (other than clear notes regarding the services provided):

• 50300 – Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral
• 50323 and 50325 – Backbench standard preparation of a living or cadaver donor renal allograft prior to transplantation …
• 50327, 50328, and 50329 – Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation …
• 51736 – Simple uroflowmetry (UFR) (e.g., stop-watch flow rate, mechanical uroflowmeter)
• 51741 – Complex uroflowmetry (e.g., calibrated electronic equipment)
• +51797 – Voiding pressure studies, intra-abdominal (i.e., rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)
• 51798 – Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging
• +52442 – Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure).

 The edits also do not apply to unlisted laparoscopy codes for renal (50549), ureter (50949), or bladder (51999) procedures, or for the general “unlisted” code 53899 (Unlisted procedure, urinary system).