Urology Coding Alert

Test yourself with these 6 questions

If you're still trying to get a grip on the changes from the National Correct Coding Initiative, version 11.2, take this quiz. These questions will test just how well you understand the new adrenalectomy and drug administration bundles. 

Hint: You can find all the quiz answers in the articles "Reporting Radioactive PVR Studies and Cystos Separately? Not Anymore" in the May 2005 issue and "Coding Adrenalectomies and Nephrectomies Separately? Time to Change Your Claims" in the August 2005 issue.

Question 1: True or false: The urologist performs a simple nephrectomy, but during the dissection also finds he must remove the adrenal gland. The nephrectomy is not considered radical because there was no node dissection, Gerota's fascia removal or thrombectomy. Because the procedure was only a simple nephrectomy, you should report the adrenalectomy separately.

Question 2: G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) is not bundled with which of the following urological procedures?

A. 50010
B. 53899
C. 52601
D. All of the above
E. None of the above

Question 3: Which CPT Code should you report when the urologist uses ultrasound to determine postvoiding residual urine?

A. 78730
B. 76775
C. 51700
D. 51798
E. None of the above

Question 4: True or false: The urologist repairs an injury to the female urethra during a urethrolysis. If you can show documentation that these were two separate services, you can append a modifier and be reimbursed for both procedures.

Question 5: NCCI Edits bundles 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]) and 60545 (... with excision of adjacent retroperitoneal tumor) with which of the following procedure codes?

A. 50225
B. 50323
C. 50543
D. Both B and C
E. All of the above

Question 6: The urologist sees a patient in his office in the morning who's complaining of flank pain. The doctor concludes the patient has a ureteral stone and administers an IM shot of Toradol. Later that evening, the urologist removes the stone in the operating room via ureteroscopy with stone basket extraction. Which codes should you report?

A. J1885 and 52352
B. G0351, J1885 and 52352
C. G0351-59, J1885 and 52352
D. Just 52352
E. None of the above.

Quick Quiz Answers

1: False. Adrenalectomies (60540, 60545 and 60650) are now an intrinsic part of 50220 (Nephrectomy, including partial ureterectomy, any open approach including rib resection). Therefore, you cannot report the codes separately. This bundle is marked with modifier indicator "1," however, so you can unbundle the codes using modifier 59 (Distinct procedural service) if you can show that the two procedures were separate. In the past, the American Urological Association has considered an adrenalectomy an integral part of both a simple or radical nephrectomy and not a separate billable service.

Answer 2: B. G0351 is not bundled with 53899 (Unlisted procedure, urinary system). On the other hand, NCCI 11.2 made G0351, along with G0353 and G0354, part of both 50010 (Renal exploration, not necessitating other specific procedures) and 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete ...). In fact, version 11.2 bundled these G codes with more than 440 urological service codes.

Answer 3: D. Report 51798 (Measurement of post-voiding residual urine and or bladder capacity by ultrasound, non-imaging). Although NCCI bundles 78730 (Urinary bladder residual study) into 46 urinary system codes, it isn't a common procedure in urological practice.

Answer 4: False. NCCI now bundles 53502 (Urethrorrhaphy, suture of urethral wound or injury, female) with 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy). This edit has a modifier indicator of "0," which means unbundling is never allowed.

Answer 5: E. NCCI 11.2 bundles 60540 and 60545 with 50225 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney). They were already bundled with 50323 (Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including ... excision of adrenal gland ...) and 50543 (Laparoscopy, surgical; partial nephrectomy) in previous versions.

Answer 6: C. Report G0351-59 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), J1885 (Injection, ketorolac tromethamine, per 15 mg), and 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus ...).

Although NCCI bundles G0351 with 52352, the edit is marked with modifier indicator "1," which allows you to report the codes separately if you have proper documentation. You should break the bundle, using modifier 59, in this case because the urologist performed the injection at the office in the morning and didn't perform the surgical procedure until later that evening.

Answers reviewed by Morgan Hause, CCS, CCS-P, privacy and compliancy officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.