Urology Coding Alert

Question: I billed Medicare for 52353,-LT and 52351-RT-59. Medicare denied 52351, stating this was bundled. I understand it is bundled on the same side, but my urologist is doing the procedures on opposite sides. Can I somehow override the bundles?

Vermont Subscriber

Answer: Under the Correct Coding Initiative (CCI) edits, Medicare considers 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) a component code for 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]). 

This bundle carries a modifier indicator of “0,” which means you can never override the edits, regardless of the circumstance. Therefore, you cannot use the anatomical modifiers RT (Right side) and LT (Left side), or the separate procedure modifier 59 (Distinct procedural service) to break this bundle. No matter the clinical circumstances, your urologist will only receive payment for 52353 when he performs these procedures during the same operative session.