Urology Coding Alert
Ureterotomy Necessity
Question: When I am billing CPT 50605 with CPT 50780 I am getting denied by HMO with the reasoning that 50605 is included in the global surgical package. I don't see a bundle under the CCI edits, so why are my claims being denied? Arizona Subscriber Answer: You are correct - there is no CCI edit that bundles 50605 (Ureterotomy for insertion of indwelling stent, all types) and 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) nor is there an edit that designates these codes "mutually exclusive" of one another. Also, the definition for CPT code 50780 does not include insertion of a ureteral stent, and 50605 is not considered an integral part of the procedure of ureteroneo-cystostomy (ureteral reimplantation). In other words, you can bill these procedures together and expect to be reimbursed for them. It appears your HMO has its own set of bundled codes and is not aware of the current CCI edits. You should definitely appeal any denials you receive for billing these codes together and send the HMO a copy of the latest CCI edits indicating that 50605 and 50780 are billable together. You should code 50780 and 50605-51 (Multiple procedures). A lot of payers don't want to see -51, so you might not need it depending on your carrier.
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