Urology Coding Alert

The Correct Coding Initiative (CCI) version 8.1, effective April 1 to June 30, 2002, includes some significant edits for urology. In most cases, unbundling is allowed with modifier -59 (Distinct procedural service).

Appendectomy: You can no longer bill for incidental appendectomy. Code 44950 (Appendectomy) is now included in open intra-abdominal genitourinary procedures: renal (50010-50020, 50040-50075, 50100-50135, 50200-50290, 50300-50380, 50400-50540); ureter (50600-50660, 50700-50940); bladder (51020-51596, 51800-51980); genital (54535, 54560, 54650, 55600-55680); and prostate (55700-55845, 55860-55865). Unbundling is never allowed.

Fine needle aspiration: Codes 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance) are now included in genitourinary biopsy procedures: renal (50200-50205); urethra (53200); genital (54100-54105, 54500-54535, 54800); and prostate (55700-55705). Unbundling with modifier -59 is allowed.

Nephrectomy: Code 50545 now includes control of postoperative bleeding (35840); lymphadenectomy (38562-38564, 38570); abdominal procedures (43653, 44200, 49320); other renal procedures (50020-50100, 50205, 50240, 50390, 50541-50544, 50546-50548); salpingo/ovarian lysis of adhesions (58660); adrena-lectomy (60540-60545, 60650); and use of the operating microscope (69990). Unbundling is allowed for all except 44200 (enterolysis) and 69990.

Renal endoscopy biopsy: Codes 50557-50559 and 50576-50578 now include endoscopic ureteral biopsy procedures 50955 and 50974. Unbundling is allowed.

Ureterostomy tube change: Code 50688* (Change of ureterostomy tube) includes antegrade urography (74425) and fluoroscopy (76000-76001). Unbundling is allowed.

Open ureteroneocystostomy repair: Codes 50780-50785 now include ureteroneocystostomy repair (50947-59048). Unbundling is allowed.

Laparoscopic ureteroneocystostomy: Codes 50947-50948 now include control of postoperative bleeding (35840); abdominal procedures (43653, 44200, 49320); injection procedure for pyelography/ureteropyelography (50394, 50684); bladder irrigation (51700); cystoscopy and stent placement (52000, 52332); dilation of the female urethra (53660-53665); catheterization (53670-53675; P9612); and the use of the operating microscope (69990). Unbundling is allowed except for 69990.

Cystostomy tube change: Codes 51705-51710 now include fluoroscopic guidance (76000-76001). Unbundling is allowed.

Ureteral stricture procedures: Bladder biopsy (52204), stent placement (52332) and meatotomy (53020) are now included in ureteroscopy codes for treatment of ureteral stricture (52344-52346). Unbundling is allowed.

Ureteroscopy procedures: Bladder biopsy (52204), fulguration (52224), and meatotomy (53020) are now included in ureteroscopy codes (52351, 52354-52355). Unbundling is allowed.

Stent placement: Code 52332 is now rebundled into ureteroscopy codes (52351-52354). It is not bundled into 52355. Unbundling is allowed. This is a reversion to a previous CCI version, and coders should follow previous CPT and American Urologists Association guidelines when placing an indwelling stent: Use 52332 in addition to the ureteroscopy procedures and append modifier -59 for payment (52332-59). Do not use 52332 for the placement and removal of a temporary ureteral catheter or stent during the procedure.

Cryoablation: Code 55873 (Cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement) is now included in prostatectomy procedures (55812-55815, 55821-55845) and brachytherapy with lymphadenectomy (55865). Code 55873 now also includes control of postoperative bleeding (35840), enterolysis (44005), mesentery procedures (44820, 44850), laparotomy (49000-49010), omentectomy (49255), cystolithotomy (51050), cystoscopy with dilation of stricture (52281), vasectomy (55250), and brachytherapy procedures (55859, 55862). Unbundling is allowed.

Intravenous infusion: Code 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) is now included in urography procedures (74400-74445, 74455). Unbundling is allowed.

Nephrectomy/donor nephrectomy: Code 50546 (Laparoscopy, surgical; nephrectomy, including partial ureterectomy) is mutually exclusive to donor nephrectomy (50547). Unbundling is allowed.

Laparoscopic sling procedures: Code 51992 is mutually exclusive to 51990. Unbundling is never allowed.

There were no deletions to the comprehensive, component, or mutually exclusive coding pairs affecting any 2002 CPT codes; the deletions only involved those codes that were deleted in 2002, such as 53443.