Urology Coding Alert

There's one more reason to keep up with the latest Correct Coding Initiative edits: Your vigilance will help you steer clear of costly modifier mistakes.

For example, if your physician performs a ureterotomy, 50605 (Ureterotomy for insertion of indwelling stent, all types), and the physician also performs ureterolysis to free the patient's ureter from abnormal adhesions, 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis), you cannot bill 50715 separately as of July 1, 2002. And without the latest CCI edits CCI 8.2 edits for July 1, 2002, through Sept. 30, 2002 you might have been left in the dark about this new bundle.

When approaching the new edits, you should be aware that they use three indicators "0," "1" and "9" to reflect whether the use of CPT modifiers with given codes is appropriate. "0" specifies that there exist no circumstances in which appending a modifier is appropriate. "1" stipulates that a modifier is allowed when differentiation between services provided is necessary. "9" indicates that there no longer exists a bundling between the specified codes deletion is effective the same date as the CCI edits' effective date.

Mutually exclusive codes represent procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary, according to Medicare. Comprehensive codes represent the major procedure or service when reported with another code; these codes represent greater work, effort and time as compared to the other code reported, Medicare says. And a component code represents a lesser procedure, often part of a major procedure or service, and is often represented by a lower RVU as compared to the code with which it is reported.

For example, mutually exclusive codes that cannot be billed together as of July 1 by the CCI 8.2 edits include minimally invasive transurethral destruction of prostate tissue codes 53853 ( by water-induced thermotherapy), 53852 ( by radiofrequency thermotherapy), and 55873 (Cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]).

CCI edits also break down Medicare's latest bundling and unbundling of codes. If you use CCI edits to supplement your CPT manual and identify comprehensive codes and components, you can avoid most modifier mistakes.

For example, CPT codes 52001 (Cystourethroscopy with irrigation and evacuation of clots) has been bundled into most diagnostic and therapeutic cystoscopic procedures from 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropy-elography, exclusive of radiologic service) to all bladder tumor resection codes (52204-52240) and all ureteroscopic procedures, according to the CCI 8.2 edits. Therefore, irrigation of clots from the bladder and cystoscopy are not separately payable under these various clinical scenarios.

Every office should supply administration with the new CCI edits to achieve excellence in coding and the best possible reimbursement, according to C.J. Wolf, MD, CPC. Codes for mutually exclusive services and comprehensive services change regularly, which affects how you can code services to yield payment.