Urology Coding Alert

Enhance your skills by utilizing guidelines from all corners of the coding universe.

However, an even more obscure manual that’s full of useful coding tidbits and instruction is the NCCI Correspondence Language Manual for Medicare Services. In it, you will find “general correspondence language” pertaining to NCCI procedure-to-procedure (PTP) edits and medically unlikely edits (MUEs) for each respective code range. While every coder should be familiar with the entirety of the manual, in this article, we’ll home in on one specific section: sequential procedures.

Get a feel for the guidelines as we work our way through this real-world urological example to fully equip you to handle all sequential procedure coding situations.

Focus on End Result with Modifier Eligibility

Before diving into the specific guidelines on how to approach surgeries involving sequential procedures, have a look at the following surgical scenario to envision how the coding dynamics might play out.

Example: The physician unsuccessfully attempts a laparoscopic nephrectomy with a partial ureterectomy. Following the unsuccessful attempt, the physician performs a successful nephrectomy using an open approach that includes rib resection.

The procedure codes in consideration are as follows:

• 50220 (Nephrectomy, including partial ureterectomy, any open approach including rib resection)
• 50546 (Laparoscopy, surgical; nephrectomy, including partial ureterectomy)

Without an extensive knowledge of the NCCI Policy Manual, you may find yourself incorrectly coding this scenario. If you perform an NCCI edits check on these two procedures, you will see that the NCCI edit details a modifier “1” indicator, meaning that you may report code 50546 (the column 2 code) alongside 50220 with an overriding modifier. However, context is crucial in determining whether or not the column 2 code is separately billable.

This is where you’ll want to consider Medicare’s policy on sequential procedures as stated in the NCCI Correspondence Manual:

“If a provider attempts several procedures in direct succession at a patient encounter to accomplish the same end, only the procedure that successfully accomplishes the expected result is reported. Generally, this occurs when a less extensive procedure fails and requires the performance of a more extensive procedure. A failed procedure followed by a more extensive procedure should not be reported separately. Procedures that are often performed in sequence have been identified and the less extensive procedure is not separately reportable with the more extensive procedure.”