Urology Coding Alert

Dive into new, revised, and deleted NCCI pairings.

Staying ahead of all the annual coding related updates doesn’t mean you can sit pretty following a review of CPT^®, HCPCS Level II, and ICD-10-CM related changes. Addendums, deletions, and revisions to National Correct Coding Initiative (NCCI) edits are an often-neglected area that can have a profound impact on reimbursement, coding, and practice management productivity. Urology has plenty of affected code combinations that could throw your coding for a loop following their April 1, 2020 implementation date.

“Keeping abreast of the quarterly changes to the NCCI procedure-to-procedure (PTP) edits is essential to coding accurately and for timely reimbursement,” says Stephan Tong, CPB, CPC, COC, AAPC Certified Medical Billing and Coding Specialist at STongRCM. “Using outdated edits in your coding process can lead to unnecessary rebilling of claims which results in longer turnaround times for payments. It can also add unnecessary charges to patient accounts, resulting in overstated receivables,” explains Tong.

Get a dose of all the relevant details to keep you informed, compliant, and coding seamlessly between patient charts and reports.

Begin With Important New NCCI Edit Pairs

The Centers for Medicare & Medicaid Services (CMS) issued a second-round of 2020 updates to NCCI procedure-to-procedure (PTP) edits that went into effect on April 1. This annual second round of updates has been known to catch coders, physicians, and practice managers off guard. Urology practices should take note of the following three newly created NCCI bundles. These three edits are considered new because, prior to April 1, 2020, there were no associated edits between the respective codes:

• 50727 (Revision of urinary-cutaneous anastomosis (any type urostomy)) and 53520 (Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure)). This bundle has a modifier indicator of 0, indicating that these two edits can never be undone or billed together, even with a modifier such as 59 (Distinct procedural service).
• 50728 (…with repair of fascial defect and hernia) and 53520. This bundle also has a modifier indicator of 0.

You may not report these code pairings together under any circumstances. However, the rules are different for the following code pair:

• 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) and 49650 (Laparoscopy, surgical; repair initial inguinal hernia). This pair has a modifier indicator of 1, so you may report these codes together under the appropriate circumstances with the use of an overriding modifier, such as modifier 59.

An overriding modifier is allowed when the surgical report clearly documents two distinct laparoscopic procedures. This is not an unusual finding in the elderly male, according to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York Stony Brook. “An inguinal hernia found at the time of a laparoscopic/robotic radical prostatectomy may be repaired laparoscopically following the prostatectomy,” he explains. In these instances, you may append modifier 59 or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/ structure) to the lower-valued column 2 code (49650).

Look Out for These Surgical and E/M Edit Deletions

Next up, you’ll want to factor in this newly deleted PTP edit for the following code pair:

• 58573 (Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)) and 38573 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed)

This deletion means that you will no longer have to consider any sort of bundling when reporting these services together during the same surgical encounter.

Keep in mind: In addition to the already mentioned surgical codes, you’ll want to take note of the deletion of the following telemedicine consultation codes paired with E/M office/outpatient visit code range (99201-99215):

• 99451 (Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time)
• 99452 (Interprofessional telephone/Internet/ electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes)

Coder’s note: These changes were implemented prior to the COVID-19 public health emergency (PHE). For office/outpatient telehealth visits that include an audiovisual component, you’ll report the respective code from code range 99201-99215. Codes 99451 and 99452 may be separately reported when the physician performs a service that meets the criteria for these codes in addition to performing a face-to-face or telehealth office/outpatient visit. You should report codes 99451-99452 when the provider spends five or more minutes evaluating a patient’s healthcare records via telephone, Internet, or electronic health record (EHR). The provider will then formulate a written report on management and treatment suggestions to the referring provider.

Don’t Forget About Revised 50605 Edits

You’ve got one more set of NCCI changes to consider. The following codes will be revised from a modifier indicator of 1 to 0 when paired with code 50605 (Ureterotomy for insertion of indwelling stent, all types). As of April 1, 2020, the following codes shall not be reported together under any circumstances with 50605:

• 50800 (Ureteroenterostomy, direct anastomosis of ureter to intestine) through 50830 (Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)
• 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes)
• 51596 (Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder)