Urology Coding Alert

Good news: Most of these pairings will accept a modifier for separate reporting.

In the last issue of Urology Coding Alert, we reviewed several sets of new Correct Coding Initiative (CCI) version 22.0 bundles. That was only a small portion of the many edits affecting urology codes you may use in your practice.

“There are so many edits it will be almost impossible to note then all, but here are several more CCI bundling edits as of Jan. 1, 2016,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.

In this article, we will review several more code pairs for which CCI will limit your coding. As in the last article, these code bundles all involve new 2016 CPT^® codes.

Use Caution Billing Nephrostomy Tube Placement and Other Similar Services

As of Jan. 1, you will find several bundles involving column one codes 50432-50435, which represent the placement, conversion, and exchange of nephrostomy tubes.

Codes 50432, 50433, 50434, and 50435 now bundle the following column two codes:

• Simple wound repair codes 12001-12007
• Intermediate wound repair codes 12041-12047
• Catheterization codes 51701-51703
• Evaluation and management (E/M) codes 99211-99255.

“Most of these edits have a modifier indicator of ‘1,’ meaning that these edits can be undone and also billed under specific clinical circumstances with a modifier,” Ferragamo says.

“With the exception of the catheterization codes and E/M services edits, the other edits will rarely be seen in general urological coding,” he adds.

Get to Know Several Renal Endoscopy Bundles

CCI 22.0 also targets several renal endoscopy codes by adding multiple bundles involving the 50551-50557 code range.

Column one code 50551 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) bundles column two new codes: 50430 (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; new access) and 50431 (... existing access). These bundles carry a modifier indicator of “1.”

Column one code 50553 (… with ureteral catheterization, with or without dilation of ureter) also bundles column two new codes: 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) and 50706 (Balloon dilation, ureteral stricture, including imaging guidance [eg, ultrasound and/or fluoroscopy] and all associated radiological supervision and interpretation [List separately in addition to code for primary procedure]). Again, you’ll be able to break these bundles with a modifier, such as modifier 59 (Distinct procedural service), in certain clinical circumstances because there is a modifier indicator of “1.”

You’ll also find the following renal endoscopy column one codes face new bundlings:

• 50555 — … with biopsy
• 50557 — … with fulguration and/or incision, with or without biopsy
• 50561 — … with removal of foreign body or calculus
• 50562 — … with resection of tumor
• 50570 — Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service
• 50572 — … with ureteral catheterization, with or without dilation of ureter

Each of those codes now bundle 50430, 50431, and 50432 as column two codes, with a modifier indicator of 1.

“The above edits indicate that percutaneous renal endoscopic procedures include (bundle) percutaneous drainage procedures (not separately payable), but under certain clinical scenarios both procedures may be billed and paid using a modifier,” Ferragamo explains.

Example: When your urologist performs a percutaneous renal endoscopy with renal stone removal (50561) in the morning, and later that same day, places a percutaneous nephrostomy tube (50432) for better postoperative drainage, you may code 50561 and 50432-59 for private and commercial payers, or 50561 and 50432-XE for Medicare. “Both coding scenarios indicating related/separate procedures performed on the same day but at separate encounters,” Ferragamo says.

Additionally: There’s one other renal endoscopy code that CCI 22.0 targets: 50575 (…with endopyelotomy [includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent]). This code now bundles new codes 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) and 50695 (…... new access, with separate nephrostomy catheter), with a modifier indicator of one.