Urology Coding Alert

Starting Oct. 1, you'll be coding 26 urology procedures differently

When your urologist destroys lesions during a laparoscopic procedure, you may have reported CPT code 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis) separately. The last set of Ncci Edits for 2004, version 10.3, includes major revisions to how you should code ureterolysis and imaging guidance for needle placement.

Surgical Laparoscopies Now Include Ureterolysis

Beginning Oct. 1, CPT 50715 will be bundled into 12 urology procedures, including codes for surgical laparoscopy of the kidney (50541-50548), testis (54690-54692), spermatic cord (55550) and prostate (55866). (See "Quick Key: Master the Ureterolysis Edits With This Tool" for details.) The National Correct Coding Initiative (NCCI) edits began bundling 50715 into major laparoscopic urological procedures in 2002; version 10.3 concludes that process.

Code 50715 is also now freshly bundled into several codes for the digestive system and female genital system surgical laparoscopy. The inclusion of the fee for ureterolysis in the fees for most genitourinary procedures is in accordance with CPT guidelines, says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind. "Lysis of adhesions is usually included in the approach,"  Kater says, especially if the lysis is to gain better access for another procedure.

The 50715 bundles are all marked with a status indicator of "1," which indicates that you can break the bundle with a modifier and report the two codes together when you have the appropriate circumstances and documentation to do so.

Example: If the urologist, while performing an orchiectomy, had to remove an unusually large amount of lesions, you could use 54690 (Laparoscopy, surgical; orchiectomy) and append modifier -22 (Unusual procedural services) to 50715 to signify the extra work, Kater says.

Follow CPT Manual's Advice for Imaging Guidance

NCCI 10.3 also bundles CPT codes 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into several urology codes. As of Oct. 1, you may not report these imaging procedures with procedures such as percutaneous nephrostolithotomy (50080, 50081) and many other percutaneous procedures, vasotomy (55300), and changes of suprapubic tubes (51705, 51710). (See "Quick Key: Find Your Way to Correct Needle Placement Coding" for all the affected codes.)

Also on Oct. 1, you may no longer report 76003 with 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). However, you will still be allowed to report 76942 with prostate biopsies.

NCCI points to instructions and guidelines within the CPT manual as their rationale for these edits. You should not report 76003 or 76942 with certain codes, NCCI says, because the CPT manual specifically directs you toward other codes for imaging guidance.

Example: Right below 50080 (Percutaneous nephro- stolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket extraction; up to 2 cm) and 50081 (... over 2 cm) in the CPT manual is this note: "For fluoroscopic guidance, see 76000, 76001."

Report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ECRP, bronchoscopy, transbronchial biopsy]) for the imaging guidance involved in the percutaneous procedures, says Sharon Powers, professional coder for Genesis Physician Services in Windsor, Conn.

52214 Bundled Into Bladder Tumor Procedures

Code 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra or periurethral glands) is now included in 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 to 2.0 cm]) as a "more extensive procedure" edit. "When procedures are performed together that are basically the same, or performed on the same site but are qualified by an increased level of complexity, the less extensive procedure is included in the more extensive procedure," explains the National Correct Coding Policy Manual.

NCCI edits in 1996 bundled 52214 into the other bladder tumor codes, 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) and 52240 (... LARGE bladder tumor[s]).

For the complete list of new NCCI edits effective  Oct. 1, visit www.cms.hhs.gov/physicians/cciedits.