Urology Coding Alert

Find out when you can -- and can't -- use -59 to override the latest edits

Reporting 52281 in tandem with cystourethroscopy for interstitial cystitis or fulguration of bladder tumors? Not anymore, according to the latest version of the National Correct Coding Initiative edits.

Don't Code Separately for Dilation

Ncci Edits version 10.1, effective April 1-June 31, 2004, bundles 52281 into:

 bladder endoscopy codes 52007 and 52010

 bladder transurethral surgery codes 52214-52234, 52250-52277, 52282, 52290-52300, 52305 and 52317-52318

 surgical cystourethroscopy, ureter and pelvis codes 52320-52330, 52334 and 52341-52355

 surgical cystourethroscopy, vesical neck and prostate codes 52400-52510, 52606, 52614-52640 and 52700.

NCCI already determined 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female) to be a component of 52235 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) and 52240 (Cystourethroscopy, with fulguration and/or resection of; LARGE bladder tumor[s]).

You may not unbundle 52281 from these codes under any circumstances. Physicians may not bill separately for the cystourethroscopy portion of any of these procedures.

But don't panic, says Karen Delebreau, coding specialist with Urological Surgeons in Green Bay, Wis. -- you probably don't need to bill separately, anyway. "I can't think of any cases where our doctors have had to bill 52281 separately with those procedures," she says. "It's not a common enough occurrence to really cause a problem."

You can still code 52281 separately for urethral dilation along with certain procedures, like cystoscopic examination (52204), retrograde pyelogram (74420) and ureteral stent placement for a ureteral stone (52332).

Break Certain Fluoroscopy Bundles With -59

NCCI 10.1 also bundles two fluoroscopy codes into several cystourethroscopy and transurethral surgery codes.

Last year, NCCI bundled fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician) into extracorporeal shock wave lithotripsy code 50590 (Lithotripsy, extracorporeal shock wave). The latest batch of edits goes further, bundling those codes into several cystourethroscopy, surgical cystourethroscopy and bladder lithoplaxy codes -- but experts say these edits shouldn't affect your reimbursement.

Now: Codes 76000 and 76001 are bundled into cystourethroscopy with ureteral catheterization codes 52005 and 52007, cystourethroscopy with removal of foreign body codes 52310 and 52315, bladder lithoplaxy codes 52317 and 52318, and all surgical cystourethro-scopy codes 52320-52355 except 52347 (Cystourethro-scopy with transurethral resection or incision of ejaculatory ducts).

Now when urologists use fluoroscopy as an additional method of visualization (for example, to place stents or remove calculi), you can no longer separately report the fluoroscopy, unless specific surgical circumstances are present, such as fluoroscopic examination at a separate encounter later that same day. In that case, you can override the edit with modifier -59 (Distinct procedural service).

Margaret Lamb, CPC, RHIT, coding specialist for the Great Falls Clinic in Great Falls, Mont., doesn't foresee a big impact for urological practices, thanks to the existing bundling of 76000 into 74420 (Urography, retrograde, with or without KUB). "Most of the time, when we've been using fluoroscopy, it's been with a retrograde urography," she says, "so we've only been able to bill for the retrograde, anyway."

Don't Sweat the Other Changes

NCCI 10.1 also bundles several EEG, EMG and reflex tests into 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) and 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique). None of the additions or deletions to mutually exclusive code pairs, nor the deletions of nonmutually exclusive code pairs, will affect urology services.

For a complete list of the latest urology-related bundles, see "Quick Key: Get the NCCI 10.1 Rundown Here" below.