Urology Coding Alert

Pay close attention to when urology codes are Column 1 vs. Column 2.

The new edition of Correct Coding Initiative (CCI) edits went into effect Jan. 1, 2019 – with almost 46,000 edits in total. Some list the urology procedure as the Column 1 code that you should report; others list the urology procedure as the Column 2 code that does not get reported. Modifier indicators showing whether you can potentially append a modifier and “unbreak” the pair to report both procedures also change depending on the procedures in question.

The edits are too extensive to cover in their entirety, but read on for an overview of some things you need to know for your practice.

Focus on When to Report the Urology Procedure

Approximately 2,500 edit pairs have a urology procedure as the Column 1 code you report. Most have been assigned a modifier indicator of 0, meaning you cannot append a modifier and report both procedures on a claim from the same encounter. But don’t miss the few pairs scattered throughout that are assigned a modifier indicator of 1, in which case you are justified in submitting both procedure codes for payment.

Several new FNA codes are the Column 2 component of pairs involving urology procedures such as 50200 (Renal biopsy; percutaneous, by trocar or needle), 50205 (Renal biopsy; by surgical exposure of kidney), and 50574 (Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy). The new codes that are considered to be components of the urology procedures are:

• 10005 – Fine needle aspiration biopsy, including ultrasound guidance; first lesion
• 10007 – Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion
• 10009 – Fine needle aspiration biopsy, including CT guidance; first lesion
• 10011 – Fine needle aspiration biopsy, including MR guidance; first lesion.

In some scenarios, you’ll find two urology procedures paired together.

For example, 50387 (Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation) and 50574 (Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy) are both Column 1 codes to new codes 50436 (Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed) and 50437 (… including new access into the renal collecting system).

Coding tip: “Before coding and billing these services be sure to check the CCI edits to determine when modifiers may be applied for payments of these services and to avoid denial of bundled services that may merit payments with the proper modifier,” advises Michael A. Ferragamo, MD, FACS,  clinical assistant professor of urology at the State University of New York at Stony Brook.

Watch for Column Changes

Those same new codes, 50436 and 50437, switch positions to become the Column 1 code (along with many other urology procedures) to the majority of repair procedures and a range of other services that are not urology-specific. A few examples include:

• 36000 – Introduction of needle or intracatheter, vein
• 62323 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
• G0463 – Hospital outpatient clinic visit for assessment and management of a patient.

Urology application: If the urologist performs an incisional biopsy or allograft when placing a bladder catheter, the edits clarify that the catheter placement is part of the biopsy or allograft service and not a separately billable service. In these edit pairs, the Column 1 codes you report are:

• +11105 – Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)
• +11106 – Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
• +11107 – … each separate/additional lesion (List separately in addition to code for primary procedure)
• +20932 – Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure)
• +20933 – … hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure)  
• +20934 – … intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure).

Each of these services overrides the work of other urology procedures:

• 51701 – Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)
• 51702 – Insertion of temporary indwelling bladder catheter; simple (eg, Foley)
• 51703 – Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon).

Bottom line: “As it has been for many years now, the placement of a urethral catheter during or following a separate procedure, urological or other specialty, has been included with the primary procedure as an integral part of the procedure and not a separately billable service,” Ferragamo says.

Skim Through Edits With 99451 and 99452

It’s no exaggeration to state that the majority of edits from this round of CCI changes involve two new codes for 2019:

• 99451 – Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
• 99452 – Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

Codes 99451 and 99452 are always listed as the Column 2 code of the edit pair in question. This signifies that the services associated with 99451 or 99452 are considered as secondary. Therefore, in these cases you should only report the other service when applicable, not 99451 or 99452.

Also important: Every edit pair that includes 99451 or 99452 has been assigned a modifier indicator of “0,” so you cannot append a modifier to unbundle the pair and report both services and expect payment for both.

Important to know: In case you ever find yourself in a situation to report 99451 or 99452 as a stand-alone service, be cautious with your reimbursement expectations. Experts such as Melanie Witt, RN, MA, an independent coding consultant in Guadalupita, NM, stress that “It remains to be seen if payers will reimburse for these services as generally a face-to-face encounter is usually required. If the payer currently does not reimburse for interprofessional services, it is probably an indication that they will also not pay for these two new services.”

“As technology communication between physicians and patients becomes more common, these two codes may be used more often by urologists as a means of providing or asking for consultative services more frequently and without a face to face encounter,” Ferragamo says. “Only time will tell us how often urologists will utilize these technology codes in their everyday practice.”