Urology Coding Alert

Question: We have just started billing urodynamics and Im running into some rejections. I billed procedures 53670, 51784, 51772, 51797, 51726, 51795 for one patient on the same date of service. The procedure code 53670 is getting rejected, saying it is included with other procedures performed that day. Is this correct?

Wisconsin Subscriber

Answer: Your challenge comes from the fact that 53670 is bundled into three of the other codes that you filed: 51772, 51797 and 51795. Heres some background to bundling. In January 1996, the Health Care Financing Administration (HCFA) implemented an initiative called the Correct Coding Initiative (CCI). The CCI specifically deals with an incorrect form of coding called unbundling.

Essentially, unbundling is billing for multiple procedure codes for a group of procedures when one or more of those codes is included in a more comprehensive code.

Unbundling can be described in a number of different ways, including:

(1) breaking out one service into component parts and coding for each part as if it were a separate service;

(2) reporting separate codes for related services when one code describes the service in full;

(3) breaking out a bilateral procedure when there is a code to describe the procedure bilaterally;

(4) downcoding a service in order to bill an additional higher-level service;

(5) separating the surgical approach from the surgical procedure.

In short, CCI was developed to help prevent incorrect coding of a group of procedures or services that can accurately be reported with a single code.

If you reference the CCI list (available from many sources including your Medicare carrier), procedure code 53670 is bundled into codes 51741, 51772, 51797 and 51795. This is done based on what HCFA calls a standard of medical practice. The bundled procedure is so integral to the procedure that it would be incorrect to list it separately. Code 53670 would, therefore, not be eligible for reimbursement in addition to the other services unless there is a separate and distinct reason for performing that service.

Since the catheterization is a necessary part of the urodynamic procedure, this would not meet the criteria. Many, if not all, third-party payers follow the CCI.