Urology Coding Alert

Additionally, 60650 is bundled into 50543 (Laparoscopy, surgical; partial nephrectomy).

All of these bundles are marked with modifier indicator "1," which means you may unbundle the codes by appending modifier 59 (Distinct procedural service), if you can show that the services were truly separate and distinct, says Donna Bertrand, coder and biller for Siouxland Urology in Dakota Dunes, S.D.

Don't Code Separately for Node Dissection

The new edits reflect long-standing urological practice, experts say.

"An adrenalectomy is included in all radical nephrectomies, whether performed open or laparoscopically," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. NCCI is also including an adrenalectomy as part of a simple nephrectomy - one that requires the urologist to remove the adrenal gland but is not a radical nephrectomy, since there was no node dissection, Gerota's fascia removal or thrombectomy, he says.

"NCCI does not feel an adrenalectomy in these cases warrants a separate charge, and I tend to agree with this,"  Ferragamo says. "I have been involved with an adrenalectomy during a simple nephrectomy on several occasions, and I never charged separately for the adrenalectomy. It appeared part of the dissection in removing either the entire kidney or an upper pole of the kidney."

"The surgeons in my group have always felt the adrenalectomy done with a radical nephrectomy was included," agrees Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.

The American Urological Association feels the same way, Ferragamo says. "The AUA has been saying for several years that an adrenalectomy is included in a radical nephrectomy," he says - so NCCI is just making that official.

This isn't the first time 60540 and 60545 have been hit by bundles. Previous bundles included 60540 and 60545 as components of the following comprehensive codes: 

Laparoscopic adrenalectomy code 60650 is already bundled into 50545, says Becky Sweat, CPC, coder and business services coordinator for the department of urology at Wake Forest University Health Services in Winston-Salem, N.C.

Say Goodbye to Separate Injection Coding

Be careful where you stick those injection G codes: NCCI 11.2 bundles three of them into virtually every urinary and male genital procedure in the CPT manual.

The latest edition of the NCCI dictates that you will no longer be able to report G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), G0353 (Intravenous push, single or initial substance/drug) or G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]) with more than 440 urological services codes.

Medicare paid the drug administration codes plenty of attention in NCCI 11.2, bundling them with over 4,000 procedures overall.

There are a few urological codes that Medicare did not include in the bundling - but they are codes you don't stand much chance of being reimbursed for to start with. Noncovered procedures such as 55970 (Intersex surgery; male to female) and unlisted-procedure codes such as 53899 (Unlisted procedure, urinary system) do not include any of the injection G codes.

Break Drug Admin Bundles With 59

Codes G0345 (Intravenous infusion, hydration; initial, up to one hour) and G0347 (Intravenous infusion, for therapeutic/diagnostic [specify substance or drug]; initial, up to one hour) are now bundled into 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]), 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) and 51703 (... complicated). Combined with the edits from NCCI 11.0, which took effect Jan. 1, 2005, NCCI 11.2 bundles the IV infusion G codes into most of the urological surgery codes.

Why? These bundles are appearing because drug administration often happens incident-to other, more major procedures, Hause says. "Typically, services that can be provided incident-to are included in larger services," he says. There could be instances when separate reporting should be allowed, he says - for example, when the drug is administered on the same day but in a different setting.

The drug administration bundles are also marked with modifier indicator "1," allowing you to report the codes separately if you have the proper documentation.

Note: To download the complete set of NCCI 11.2 edits, visit www.cms.hhs.gov/physicians/cciedits.