Urology Coding Alert

Edits focus on updated CPT® codes.

 January 1 each year brings not only procedural code changes, but a slew of Correct Coding Initiative (CCI) edits affecting the new codes. 2016 is no exception. Version 22.0, which took effect on Jan. 1, 2016, adds 57,161 new bundles and deletes 20,842 more, and many of those involve urology codes.

“The 2016 CCI edits, version 22.0, bundle a great number of urological codes/services with other CPT® codes both for urology and other organ systems,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.

Combing through lines and lines of new CCI bundlings to find the ones that affect urology can take time you don’t have. So we’ve made it easy and did the scouring for you. Read on to get a rundown of the CCI 22.0 edits you need to incorporate into your urology coding.

First, Review the 2016 CPT® Changes

Many of the new CCI bundles affecting urology focus on the new CPT® codes. CPT® deleted six urological procedure codes as of Jan. 1, 2016, replacing them with other codes as follows:

• Deleted code 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous) was replaced by code 50432 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance [eg, ultrasound and/or fluoroscopy] and all associated radiological supervision and interpretation)
• Deleted code 50393 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous) was replaced by code 50693 (Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance [eg, ultrasound and/or fluoroscopy], and all associated radiological supervision and interpretation; pre-existing nephrostomy tract)
• Deleted code 50394 (Injection procedure for pyelography [as nephrostogram, pyelos­togram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter) was replaced by code 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance [eg, ultrasound and fluoroscopy] and all associated radiological supervision and interpretation; existing access)
• Deleted code 50398 (Change of nephrostomy or pyelostomy tube) was replaced with code 50435 (Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance [eg, ultrasound and/or fluoroscopy] and all associated radiological supervision and interpretation)
• Deleted code 74475 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpre­tation) — the radiology code for nephrostomy tube placement — has no direct replacement code. Code 50432 replaced reporting 50392 and 74475 together.
• Deleted code 74480 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation) — the radiology code for ureteral catheter/stent placement — has no direct replacement code. You now report 50693 instead of 50393 and 74480.

CCI 22.0 updates its bundles to focus on the new codes.

Include Stent Placement in PCNL Code

Column one percutaneous nephrostolithotomy (PCNL) codes 50080 and 50081 now bundle new 2016 second column codes 50693, 50694 (… new access, without separate nephrostomy catheter), and 50695 (…, with separate nephrostomy catheter), all representing percutaneous placement of a ureteral catheter or stent.

“These edits emphasize that CPT® codes 50080 and 50081 include antegrade stenting as part of their overall procedure and do not represent an additional billable service,” Ferragamo explains.

Caveat: Each has a modifier indicator of “1,” meaning that you can override the bundle with a modifier under specific clinical circumstances.

Example: Your urologist performed a PCNL on the left kidney and at the same encounter performed the percutaneous placement of a ureteral stent into the right kidney. You would be justified in using a modifier to separately report these services in this clinical scenario, Ferragamo says. First, report 50081 with modifier LT (Left side) attached. Then, report 50693 with modifiers XS (Separate structure) and RT (Right side) for Medicare or 50693 with modifiers 59 (Distinct procedural service) and RT for private payers.

Additionally: Under CCI 22.0, you will also now find 50080 and 50081 bundle all of the following codes:

• Fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [eg, cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional [eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy])
• Ultrasound codes 76942 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpre­tation), 76970 (Ultrasound study follow-up [specify]), and 76998 (Ultrasonic guidance, intraoperative)
• CT and MRI guidance codes 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) and 77021 (Magnetic resonance guidance for needle placement [eg, for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation).

These edits also have a modifier indicator of “1.”

Update Your Renal Bundles

CCI 22.0 bundles renal biopsy code 50200 (Renal biopsy; percutaneous, by trocar or needle) with the same radiology codes listed above. Therefore, you will not be able to report 50200 with 76000, 76001, 76942, 76998, 77012, or 77021.

However, because of a “1” modifier indicator you will be able to use a modifier if clinical circumstances warrant separate billing of all these codes.

Renal catheter edits: You will also find renal pelvis catheter procedure codes 50382 (Removal [via snare/capture] and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation), 50384 (Removal [via snare/capture] of internally dwelling ureteral stent …), 50387 (Removal and replacement of externally accessible nephroureteral catheter [eg, external/internal stent] requiring fluoroscopic guidance, including radiological supervision and interpretation), and 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous) now bundle the following codes:

• 50430
• 50431
• 50432
• 50693
• 50694
• 50695
• 76970
• 77012
• 77021.

Also: CCI 22.0 also bundles column two codes 50693, 50694, and 50695 with column one code 50385 (Removal [via snare/capture] and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation), with a modifier indicator of “1.”

All of these renal code bundles carry a modifier indicator of “1,” Ferragamo says. “One should only unbundle an edit between codes if the procedures bundled in a particular clinical situation are distinct and separate procedures or services unrelated to each other,” he adds. “Often the edits are confusing and difficult to easily separate causing uncertainty in how to code and what modifiers should be used.”

Capture E/M and Wound Repairs In Main Procedure Codes

As is typical in the first round of CCI for the year, version 22.0 bundles evaluation and management, wound repair, and radiology codes with several new CPT® codes. New codes 50430 and 50431 bundle wound repair codes 12001-12007 and 12041-12047, as well as intermediate and complex repair codes, catheter placement codes 51701-51703, as well as office and hospital E/M codes 99211-99255. Most of these edits carry a modifier indicator of “1.”

“Many of the new 2016 percutaneous non endoscopic procedures will include E/M hospital and office visit codes as well as ultrasound, CT, and MRI guidance codes,” Ferragamo adds. “When using these new codes check your CCI manual for specific bundling issues.”

Stay tuned: This is only the beginning of the CCI edits you’ll need to know in urology. We’ll review additional urology edits in the next issue of Urology Coding Alert.