Urology Coding Alert

New CCI bundles target new 2014 codes.

Every Jan. 1 brings code changes, and every new year the Correct Coding Initiative (CCI) adds bundling edits right along with those new and revised codes.

“As is customary for the first update of a given year, there are a lot of new edit pairs: 61,120 to be exact,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. “Factor in the number of terminations (13,107) and we see a net gain this coming quarter of 48,013 new edit pairs.”

For urology coders, the version 20.0 edits bring several edits that may affect their claims. Read on to learn about transitional care management, phone/Internet consultation code, renal drainage, and other CCI bundles that you need to apply to your Q1 coding.

Skip TCM Billing With Many Other Codes

As of Jan. 1, 2014, CCI bundles transitional care management (TCM) codes (99495-99496, Transitional Care Management Services with the following required elements: Communication [direct contact, telephone, electronic] with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit ...) into many urological codes.

“If you plan to report a surgical or medical procedure and a TCM code, you may face denials of these 30-day service codes if you bill the TCM code and the surgical or medical procedure on the same day,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “TCM codes also may be bundled and not reimbursed when billed on the same day as an I & D of an abscess (10600). In this case only the I & D will be paid because of the new edits.”

A few of the TCM code edits have a modifier indicator of “1;” however, most have a modifier of “0.” A “0” indicator means that you cannot unbundle the two codes under any circumstances, says Chandra L. Hines, practice manager of WSP Capital Urology in Raleigh, NC. An indicator of “1,” however, means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment, she adds.

Tip: The most common modifiers that urology practices use to override an edit pair are 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) when used with an associated E/M code, or modifier 59 (Distinct procedural service) when two non-E/M services, such as bundled surgical procedures, are performed; however, other modifiers may apply in some circumstances.

Additionally: You’ll also notice that CCI 20.0 bundles inter-professional telephone or Internet consultation codes (99446-99449, Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional ...) are bundled into many urological codes (50010-55920) as well as many other CPT® codes.

Don’t Count on 49496, 44905 Pay

You’ll find that CCI is tying your hands on reimbursement for 2014 CPT® code 49406 (Image guided collection drainage, peritoneal or retroperitoneal, percutaneous). Version 20.0 bundles this new code into procedure codes 50020-55920 with a modifier indicator of “1,” meaning that these bundling edits may be undone/overridden with a modifier in some specific clinical scenarios.

CPT® also added 49405 (Image guided collection drainage by catheter {eg, abscess, hematoma, seroma, lymphocele, cyst}; visceral {eg, kidney, liver, spleen, lung/mediastinum} percutaneous) on Jan. 1, 2014. CCI bundles 49405 into procedure code 50020 (Drainage of perirenal or renal abscess, open) with another modifier indicator of “1.”

“This indicates that one may bill for both an open and percutaneous renal or peri-renal drainage during the same encounter if both procedures are needed to complete the drainage,” Ferragamo says.

Plus: New 2014 code 10030 (Image guided catheter fluid drainage) bundles and includes most E/M codes (99211-99239), wound repair codes, and topical anesthesia codes, Ferragamo adds.

Include Ancillary Stone Procedures With PCNL Procedures

As of Jan. 1, percutaneous nephrostolithotomy codes 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50081 (... over 2 cm), now bundle the following urological endoscopy codes:

• 50561 — Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 50961 — Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 50980 — Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 52320 — Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus
• 52325 — Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)
• 52330 — Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus
• 52352 — Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
• 52353 — Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included).

“These are cystoscopic and ureteroscopic ancillary stone procedures, and these edits will not allow their coding with the PCNL procedures,” Ferragamo explains. “These edits have a modifier indicator of ‘1,’ which may allow billing these bundled procedures with a PCNL under special clinical circumstances.”

Watch ESWL Edits, Too

In the mutually exclusive codes, column one ESWL code 50590 (Extra corporeal shock wave lithotripsy) bundles column two code 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [eg, Gibbons or double-J type]). This edit also carries a modifier indicator of 1.