Urology Coding Alert

The key: Pay attention to indicators 1 and 0 to prevent denials and capture payment

The hardest hit codes in the National Correct Coding Initiative version 12.0 edits are the new injection codes, which NCCI now bundles with most urological services and procedures. Good news: You’ll be able to use a modifier to unbundle some--but not all--of the code pairs that took effect Jan. 1.

New Drug Administration Codes Mean New Bundles

The newest set of edits bundles the following drug administration codes with most column 1 urinary system codes, column 1 male genital system codes, and column 1 female genital system codes, says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook:

• 90760--Intravenous infusion, hydration; initial, up to 1 hour

• 90765--Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

• 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

• 90774--…intravenous push, single or initial substance/drug

• +90775--…each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure).

Although the injection code bundles are significant and important because they limit the drug administration services you can report with major surgical procedures, urology coders expected the edits, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.

Don’t Report Anesthesia Separate From Renal Ablation

NCCI 12.0 bundles the column 2 codes for injections and intravenous therapy (36000, 36410, 37202) and local anesthetic codes (62318, 62319, 64415-64475) into new 2006 codes 50250 (Ablation, open, one or more renal mass lesion[s], cryosurgical, including intraoperative ultrasound, if performed), 50382-50389 (renal pelvic catheter codes) and 50592 (Ablation, one or more renal tumor[s], percutaneous, unilateral, radiofrequency).

Note: The column 2 codes have a modifier indicator of “1,” which means you can report both codes using a modifier, such as modifier 59 (Distinct procedural service), under specific clinical circumstances.

The Jan. 1 round of edits also bundles +69990 (Microsurgical techniques, requiring use of operating  microscope [list separately in addition to code for primary procedure]) into the renal ablation and pelvic catheter codes (50250, 50382-50389 and 50592). Code 69990 has a modifier indicator of “0,” so you can never report this code separately when billing codes 50250, 50382-50389 or 50592.

NCCI 12.0 makes clear that as indicated in its CPT Codes definition, 50250 includes ultrasonic studies 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation), 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), and 76986 (Ultrasonic guidance, intraoperative).

The edits also bundle 43752 (Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) and 44950 (Appendectomy) into 50250. These bundles have a modifier indicator of “1.”

Also, note that codes 50382-50389 include fluoroscopy (76000-76003) and ultrasound (76942 and 76986). The NCCI 12.0 edits especially clarify that 50389 (Removal of nephrostomy tube, requiring fluoroscopic guidance [e.g., with concurrent indwelling ureteral stent]), “although not particularly clear in its definition as to whether one could or could not bill for fluoroscopy, does indeed include fluoroscopy as a bundled component, which then does not and should not warrant a separate charge,” Ferragamo says.

Bonus: Code 50592 does not include any radiological guidance studies, so you can report the procedure code and any radiology procedures your urologist performs. For example, you can bill 50592 with computed tomography (CT, 76362), magnetic resonance imaging (MRI, 76394)  or ultrasound (76940), if your physician uses any one of these technologies for guidance or for the monitoring of tissue response.

44180 Bundles Support Urologists’ Understanding

NCCI 12.0 also targets new CPT code 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). The new edits bundle 44180 into many open and laparoscopic urological procedures, such as laparoscopic radical nephrectomy (50545) and ureteroileal conduit (50820), and many female and male genital procedures, such as exploration for undescended testis (54560) or vaginal colpopexy (57282).

“For some time now, most urologists have understood that lysis of adhesions is included in most laparoscopic and open procedures as a bundled service,” Ferragamo says. You shouldn’t typically report adhesiolysis separate from a urological procedure, and Medicare is continuing to support this rule in these edits, Hause adds.

Lymph Node Resection Prompts 51595 Bundles

You won’t be able to report certain hysterectomy procedures and a complete cystectomy together now that NCCI 12.0 is in effect. The edits bundle the following hysterectomy codes into 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lympha-denectomy, including external iliac, hypogastric, and obturator nodes):

• 58200--Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)

• 58210--Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s).

Reasoning: Because procedure code 51595 includes a pelvic node resection, if you also report 58200 or 58210 for a hysterectomy at the time of the total cystectomy, you would be double-billing for the lymph node resection, Ferragamo says.

Tip: You can continue to bill 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]) when your physician performs a hysterectomy with a complete cystectomy (51595) because the code descriptor for 58150 does not specify pelvic lymph node resectioning.

You Can’t Report 0137T With Prostatectomies

NCCI bundles Category III code 0137T (Biopsy, prostate, needle, saturation sampling for prostate mapping) into column 1 prostatectomy codes 52601, 52647, 52648, 53850-53853, 55866, and open prostate biopsy code 55705. All of these bundles have a modifier indicator of “1,” so you can break the bundle in certain situations.