Urology Coding Alert

Watch for new coding edits designed to stop 'double-dipping' for post-void residual studies

 If you're coding urinary bladder residual studies using radioactive materials separately from catheterization or cystourethroscopy codes, NCCI would like a word with you. That word is "stop."
 
The second set of National Correct Coding Initiative edits for 2005, version 11.1, bundles nuclear medicine service code 78730 (Urinary bladder residual study) into 46 urinary system codes in order to counteract "misuse" of that code. Translation: Coders have been separately reporting 78730 inappropriately, and NCCI is putting a stop to it. Other new coding edits will affect how you code transvaginal urethrolysis.
 
Reminder: These NCCI edits went into effect April 1, 2005.

Include 78730 in Cysto, Cath Procedures

NCCI Edits version 11.1 mandates that you consider 78730 an intrinsic part of 151 procedures, including urinary system procedures, echocardiography procedures and other radiology procedures. Medicare has assigned modifier indicator "0" to these code pairs, meaning you are not allowed to report 78730 separately along with any of the comprehensive codes, even if you append a modifier, says Dolly Perrine, CPC,   CCS-P, coder and biller for Bend Urological Associates in Bend, Ore.
 
Other PVR tests - including bladder scans (76775, Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) and urodynamics (51725-51798) - now also include 78730, according to NCCI.
 
NCCI 11.1 also bundles 78730 into most of the E/M codes from 99201 to 99350. These bundles are marked with modifier indicator "1," which means you can append a modifier to break the bundle when the documentation indicates two separate services.
 
Why? CMS is trying to stop "double-dipping" for PVR, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. "Most of the comprehensive codes are procedures where a catheter is inserted or a cystourethroscopy is performed, by which a PVR can be obtained as well," Hause says. Catheter insertion is already considered an intrinsic part of the cysto codes, he says.
 
Despite the number of codes affected, this edit does not necessarily have earth-shattering implications for your practice, says Bruce Hammond, CRA, CNMT, COO of Diagnostic Health Services in Texas. "[Procedure] 78730 is very uncommon," he says. "The bulk of these are done at children's facilities for follow-up to recurrent urinary tract infections (UTI), most often in girls."
 
"Urologists will rarely perform this procedure (78730) to determine post-voiding residual urine volume, as this is a nuclear medicine study necessitating radioactive materials and special equipment for radioactive scanning," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. "The important point here is that this code should not be billed when one uses ultrasound to determine the post-voiding residual urine." The proper code for that procedure: 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging), Ferragamo says. "In fact, most urologists are not credentialed to handle radioactive materials or use radioactive scanners," he says.

Don't Separate Urethrorrhaphy From Urethrolysis

Another code seeing plenty of new edits from NCCI 11.1 is 53500 (Urethrolysis, transvaginal, secondary, open, including cystourethroscopy [e.g., postsurgical obstruction, scarring]).
 
CPT code 53500 now includes:
 

 Bladder irrigation (51700)
 

 Urethrotomy (53000-53010)
 

 Meatotomy (53020)
 

 Drainage of perineal urinary extravasation (53080)
 

 Urethrorrhaphy (53502, 53510) 
 

 Urethrostomy or urethrocutaneous fistula closure (53520).

Penile urethrorrhaphy code 53505 and male urethrostomy or urethrocutaneous fistula closure code 53520, as well as urethral stricture dilation codes 53600-53621, are all now mutually exclusive with 53500. Why? Anatomy, Ferragamo says. All of these are male-specific codes, whereas 53500 specifically describes a transvaginal approach (females only). "These male codes would seem appropriately labeled as mutually exclusive with 53500,"  Ferragamo says.
 
Don't miss: "Repair of an injury to the female urethra (53502, Urethrorrhaphy, suture of urethral wound or injury, female) during a urethrolysis (53500) now is bundled into the urethrolysis procedure itself," Ferragamo says. "This bundle has a '0' modifier, indicating that a repair of an injury will no longer be paid as separate and distinct from the urethrolysis itself." In this case no unbundling will be allowed.

Watch for Sling and Cystectomy Bundles

Among NCCI 11.1's other new edits:
 

 Code 52000 (Cystourethroscopy [separate procedure]) is now bundled into column 1 code 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]). "Because of the confusion concerning cystoscopy as an integral part of a sling procedure, cystourethroscopy will no longer be separately reimbursed when billed together with 57288," Ferragamo says. The "0" modifier indicator prevents unbundling.

 Code 51565 (Cystectomy, partial, with reimplantation of ureter[s] into bladder [ureteroneocystostomy]) now includes ureteroneocystostomy codes 50780-50785 as component codes. These bundles are marked with modifier indicator "0" and cannot be broken.

 Code 51820 (Cystourethroplasty with unilateral or bilateral ureteroneocystostomy) is now considered a component of ureteroneocystostomy codes 50782-50785. NCCI considers the comprehensive codes to be more extensive procedures than 51820. These bundles are also marked with modifier indicator "0."

Note: For a complete look at how NCCI 11.1 will affect urology coding, see "Quick Key: Get the NCCI 11.1  Skinny Here" on page 36.