Urology Coding Alert

Find out which edits you can't break with modifier 59

If you code for either a urologist who performs female genital tract procedures or a urogynecologist, you'll want to pay attention to another group of NCCI Edits that incorporate new female procedure codes.

Several codes are now bundled into new code CPT 57296 (Revision [including removal] of prosthetic vaginal graft; open abdominal approach). When your physician performs an open abdominal revision of a vaginal graft, you'll no longer be able to also report codes for:

• venous access (36000, 36410, 37202)

• placement of a naso-gastric tube (43752)

• enterolysis (44055, 44180)

• mesentery surgical procedures (44820, 44850)

• appendectomy (44950)

• exploratory laparotomy (49000-49010)

• omentectomy (49255)

• diagnostic laparoscopy (49320)

• repair of epigastric hernia (49570)

• urethral catherizations (51701, 51702)

• perineoplasty (56810)

• vaginal mucosa biopsy (57100)

• vaginal packing (57180)

• creation of artificial vagina (57291-57292)

• vaginal graft removal via vaginal approach (57295)

• vaginal examination and removal of vaginal foreign body (57400-57415)

• colposcopy (57420, 57452)

• cervical biopsy (57500)

• diagnostic and therapeutic nervous system injections (62318, 62319, 64415-64417, 64450, 64470, 64475)

• intravenous and other injection codes (90760, 90765, 90772, 90774, 90775).

"It is not a real surprise that they added some abdominal procedures as included with the abdominal mesh repair, but these edits go far beyond those for code 57295 (vaginal approach for the same procedure)," says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M. "In my opinion, bundling procedures for vaginal procedures is inappropriate when you are talking about removing mesh through an abdominal approach, and I would hope that ACOG would challenge these edits."

Modifier help: These edits have a modifier indicator of "1." This means you can override the edits by reporting both codes with a modifier, such as modifier 59 (Distinct procedural service), appended to the bundled code, and expect to be paid on both under the proper clinical circumstances.

More: In addition, there are two more codes that NCCI bundles into 57296 -- 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified) and +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). However, both of these bundles have a modifier indicator of "0," meaning that these edits cannot be bypassed or broken with any modifier.