Urology Coding Alert

Plus, CCI bundles 96402 and 90772 with even more E/M codes

If you've been reporting the removal of bladder stone fragments that have fallen into the bladder after ureteroscopic extraction or ureteroscopic fragmentation, the Correct Coding Initiative wants a word with you -- and that word is "stop." Take a look at the new edits you're faced with starting April 1.

No Exceptions to New 52315 Edits

CCI version 14.1 bundles 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) into 52315 (... complicated). This edit makes sense because you wouldn't perform both a simple and a complicated cystourethroscopy with foreign-body removal during the same session, says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind.

In addition: The ureteroscopy codes 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) and 52353 (... with lithotripsy [ureteral catheterization is included]) now bundle 52315. This has a modifier indicator of 0, which means you can never bypass the edit and separately report the bundled services.

"This means that when the urologist fragments and removes a stone from the ureter and fragments fall into the bladder, and the urologist then removes them from the bladder using a grasping device, that secondary service is now included in the global of the original ureteroscopic procedures," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook.

More edits: Endoscopic vesicle neck and prostate surgery codes 52402, 52601, 52647, 52648 and 52649 now also include both 52310 and 52315.

Each of these bundles has a modifier indicator of 0. "The urologist can no longer bill for the latter codes and be paid for cystoscopic extraction of bladder debris, prostatic chips or calculi at the same time as the other procedures," Ferragamo says. "Some of the laser procedures often lead to prostatic debris or coagulated prostatic material floating into the bladder, and now their cystoscopic removal isn't separately billable but included in the overall primary prostatic procedure."

Pay Attention to These Additional Edits

The prostatic excision codes for open prostatectomies (55801-55845), laparoscopic prostatectomy (55866), and cryosurgical prostatic ablation (55873) will now all include 55876 (placement of markers for radiation therapy). Each of these bundles has a modifier indicator of 1, except for 55845, which has an edit of 0. A modifier indicator of 1 means that you can break the bundle using a modifier in certain clinical circumstances.

Other edits of note:

• CCI 14.1 also targets E/M codes. More E/M codes, including 99217-99220, 99223, 99231-99236, 99251-99255, 99281-99285, 99291-99293, will now bundle 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic) and 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). Most of these edits have a modifier indicator of 1. Urologists frequently use 96402 and 90772 for their luteinizing hormone-releasing hormone (LHRH) injections and antibiotic or testosterone administrations, Ferragamo says.

• Code 51597 (pelvic exenteration) now includes 58548 (Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with removal of tube[s] and ovary[s], if performed), 58957 (Resection [tumor debulking] of recurrent ovarian, tubal, primary peritoneal, uterine malignancy [intra-abdominal, retroperitoneal tumors], with omentectomy, if performed) and 58958 (... with pelvic lymphadenectomy and limited para-aortic lymphadenectomy). Each of these bundles has a modifier indicator of 1. Your urologist may use some of these codes, especially if he deals in oncological urology, Ferragamo says.

• If your urologist performs many pediatric procedures, take note that bladder catheterization codes 51701 and 51702 are now bundled into inpatient pediatric critical and intensive care codes 99293, 99294 and 99299 with an indicator of 1.