Urology Coding Alert

NCCI 10.2 affects laparoscopies, lidocaine injections and catheters

Be careful how you code for laparoscopic radical prostatectomies and lidocaine injections starting this month. Version 10.2 of the National Correct Coding Initiative edits, which takes effect July 1, dramatically changes which urology Codes you can -- and can't -- report along with 55866 and J2001.

Last year, Ncci Edits bundled 51701 (Insertion of non-indwelling bladder catheter) and 51702 (Insertion of temporary indwelling bladder catheter; simple) into 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging). NCCI 10.2 deletes that bundle -- so you may now report 51701 or 51702 with 51798 without using a modifier.

This is a welcome change, says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind. "Our doctors frequently will perform an ultrasound for post-void residual, find the patient is not emptying the bladder, and then find it necessary to place a catheter," she says. "Before, we weren't able to recoup for the 51798 -- we would just bill the 51702, usually." Being able to bill for 51798 will bring an extra $14 in per procedure -- not a fortune, Kater admits, but since her urologists do the procedure frequently, it should add up quickly.

The E/M code 99211 (Office or other outpatient visit for the E/M of an established patient ...) still remains bundled into 51798. NCCI has given the codes a modifier status indicator of "1," which means you can report them together under certain circumstances by adding a modifier to the second procedure. Remember, however, that Medicare does not recognize modifier -59 (Distinct procedural service) when appended to an E/M service and will not reimburse.

The latest edits have determined that laparoscopic prosta-tectomy - 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing) - is mutually exclusive with transurethral resection of prostate procedures (52601, 52612-52648) and prostate excision procedures (55801-55831). Brachytherapy code 55859 (Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy) and exposure of prostate codes 55860-55865 are also now mutually exclusive with 55866. According to CMS, a physician would not usually perform any of these procedures along with 55866 on the same patient on the same day. This bundle has a status indicator of "1," so you can unbundle under certain circumstances by adding a modifier to the second procedure.

CMS has also determined that CPT codes 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach), 55705 (... incisional, any approach), 55840 (Prostatectomy, retropubic radical, with or without nerve sparing) and 55842 (... with lymph node biopsy[s]) are integral parts of, and therefore bundled into, 55866. Under certain circumstances, however, you can report these procedures with 55866 by appending an appropriate modifier to the procedure code.

What you cannot do now, under any circumstances, is report 55866 with 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes). Code 55866 is now considered an integral part of 55845, and the modifier status indicator of "0" means the procedure cannot be unbundled.

If you're using the new HCPCS code J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) for lidocaine injections, watch out: It's now considered bundled with 77 urology procedures and services. Renal endoscopy, bladder incision, cystourethroscopy and penile biopsy are a few of the procedures that lidocaine injections are now bundled into.

Remember that J2001 is only for intravenous injection of lidocaine. J2000, the code for topical lidocaine as instilled into the urethra for anesthesia before endoscopy, was deleted this year and is no longer a viable code. Medicare does not reimburse for any type of anesthesia -- topical, local or regional -- when administered by the operating surgeon or urologist under any circumstances. You can use modifiers to break the bundles under certain circumstances.

NCCI 10.2 also makes some bundling changes in the 5054x series (Laparoscopy, surgical). Code 50541 (... ablation of renal cysts) is now bundled into 50542 (... ablation of renal mass lesion[s]), with no unbundling allowed. Both 50541 and 50542 are bundled into 50543 (... partial nephrectomy), with unbundling allowed. And both 50542 and 50543 are themselves bundled into nephrectomy codes 50545-50548, also with unbundling allowed.

For a complete rundown on how urology CPT codes are affected by NCCI 10.2, see the Quick Keys on pages 51 and 52.

For a complete list of NCCI edits, go online to www.cms.hhs.gov/medlearn/ncci.asp.