Urology Coding Alert

The latest version of the National Correct Coding Initiative (NCCI) edits perpetuates the trend of incorporating the new 2003 CPT Codes into the current set of bundles and this time it's ESWL that's under scrutiny.

NCCI Edits version 9.2, which goes into effect July 1, contains a few new urology-related bundles but no pertinent additions to the current set of mutually exclusive codes.

The edit most likely to affect your urology practice is the bundling of fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) into extracorporeal shock wave lithotripsy code 50590 (Lithotripsy, extracorporeal shock wave).

Now when urologists use fluoroscopy to localize the stone, the fluoroscopy is no longer separately billable unless specific surgical circumstances are present, such as fluoroscopic examination at a separate encounter later that same day, in which case you can override the edit with modifier -59 (Distinct procedural service).

Coders should note that if the urologist reads the flat film (74000, Radiologic examination, abdomen; single anteroposterior view) just prior to starting ESWL and also to determine the degree of fragmentation of the stone during ESWL, you may still report and get paid for 74000 as a separate service.

The bundling of the donor and recipient nephrectomy codes 50300, 50320, 50340 and 50365 into laparoscopy codes 50542 (Laparoscopy, surgical; ablation of renal mass lesion[s]) and 50543 ( partial nephrectomy) is another highlight of the latest edits and prohibits urologists from being separately paid for renal transplants when performed with laparoscopic surgery of the kidney.

Also of significance to urology coders: NCCI 9.2 bundles 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) into 76872 (Echography, transrectal), 76873 ( prostate volume study for brachytherapy treatment planning [separate procedure]) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).

According to the edits, many of the new bundles may be unbundled and separately reported using modifier -59 (Distinct procedural service) when appropriate (see "Modifier -59 Is Not Your License to Unbundle").

For a complete list of the latest urology-related bundles, see "Quick Key: Get the NCCI 9.2 Rundown Here."