Urology Coding Alert

Tip: Check the edits before separately reporting 69990

As soon as CPT Codes adds new codes, the National Correct Coding Initiative (NCCI Edits ) is right there to limit how you can use those codes. Let our experts guide you through the myriad of urology bundles that you’ll face during the first quarter of this year.

Use Add-On Code 38747 for Full Payment

As of Jan. 1, you won’t be able to report lymphadenectomy codes 38562 (Limited lymphadenectomy for staging [separate procedure]; pelvic and para-aortic) and 38564 (... retroperitoneal [aortic and/or splenic]) when your urologist performs a radical nephrectomy (50230, nephrectomy ... radical, with regional lymphadenectomy and/or vena caval thrombectomy) and an extended lymphadenectomy.

No modifier help: These new bundles have modifier indicator of “0,” meaning that these edits cannot be bypassed or broken with any modifier.

Solution: Because of these edits, if your urologist does perform an extended lymphadenectomy at the time of the radical nephrectomy, you should report 50230 and code +38747 (Abdominal lymphadenectomy, regional ...) to indicate that the physician performed an extended node resection, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

Tip: Since 38747 is an add-on code, you do not need to add modifier 51 (Multiple procedures) to your claim.

Update Your Guidance Code Choices

NCCI 13.0 targets ultrasonic guidance code 76998 (Ultrasonic guidance, intraoperative) and fluoroscopic guidance code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). The latest set of edits bundles both 76998 and 99002 into many percutaneous renal procedures (50021, 50080, 50081, 50382-50387, 50392, 50394-50398) and one open renal procedure (50250).

In addition, 77002 is now bundled into two cystostomy tube change procedures: 51705 and 51710.

Difference: These bundles carry a modifier indicator of “1,” which 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 for both under the proper clinical circumstances.

When your urologist performs a microwave treatment of the prostate (53850, Transurethral destruction of prostate tissue; by microwave thermotherapy), you’ll no longer be able to separately report 52510 (Transurethral balloon dilation of the prostatic urethra).
 
Reminder: This bundle carries a modifier indicator of “0.” The “0” indicator means you may not use any modifiers to unbundle the edit under any circumstances, so you’ll no longer be paid separately for the dilation, Ferragamo says.

Don’t Count on Modifiers With 55875 Bundles

New code 54865 (Exploration of epididymis, with or without biopsy) replaced 54820, which carried the exact definition as the 2007 code. NCCI made sure to mirror 54865 bundles to the edits 54820 carried. Code 54865 includes all the bundled column 2 codes that 54820 carried, including 36000, 36410, 37202, 43752, 54500, 54505, 62318, 62319, 64415-64417, 64450, 64470, 90760, 90765, 90772, 90774, and 90775.

All of the new 54865 bundles have a modifier indicator of “1,” which means you may be able to report both codes using a modifier as indicated above, when appropriate, Ferragamo says.

In addition: NCCI also bundles 54865 with +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]), but this has a modifier indicator of “0.”

Another new code that is simply a renumbering of an old code -- 55875 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) replaced 55859 -- is also an NCCI 13.0 target. Code 55875 now includes all bundled column 2 codes that the old CPT code (55859) did, including specific urology catheterization codes 51701, 51702 and 51703 as well as cystoscopy codes 52000 and 52250. These urology code edits have a “0” modifier indicator.

The latest NCCI edits also target another 2007 code: 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple). This guidance code now includes venous access 36000, 36410, 37202, naso-gastric tube placement 43752, diagnostic and therapeutic nervous system injections 62318, 62319, 64415-64417, 64450, 64475, and intravenous and other injection codes 90760, 90765, 90772, 90774, and 90775. These code pairs all have an indicator of “1.”

Note: NCCI also now bundles 69990 into 55876, but this edit has an indicator of “0.”

Good news: There’s “nothing surprising” in the first round of NCCI edits, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, 2-urogynecologist practice in Indianapolis. The majority of the bundles incorporate new CPT codes, and urology coders expected them.