Urology Coding Alert

NCCI says debridement is already included in 3 urology procedure codes

You can’t report the treatment of necrotizing soft-tissue infections along with the removal of various urological implants without appending a modifier, thanks to the National Correct Coding Initiative, version 12.1.

Check to See if Procedure Codes Include Debridement

If a urologist in your practice is removing a urological implant and has to perform debridement due to Fournier’s gangrene, you won’t be able to separately report the implant removal procedure and the treatment of the necrotizing tissue infection.

NCCI 12.1 bundles 11004 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft-tissue infection; external genitalia and perineum), 11005 (... abdominal wall, with or without fascial closure) and 11006 (… external genitalia, perineum and abdominal wall, with or without fascial closure) with the following codes:

• 53448--Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement of infected tissue

• 54411--Removal and replacement of all components of a multicomponent inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

• 54417--Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue.

With these new bundles, NCCI Edits is “saying that if you remove these infected prostheses and replace them, the representing codes also include debridement of the skin, subcutaneous and necrotizing tissue,” says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York, Stony Brook.

Use Modifier 59 to Override Implant Bundles

These bundles have a modifier indicator of “1,” so you can append a modifier (e.g., 59, Distinct procedural service) and separately report the services if your urologist’s documentation supports the distinct procedural services.

“The services reflected by 11004-11006 should be separately reportable if the debridement goes beyond the surgical field of the implant,” says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. “I am glad there is a ‘1’ status indicator because this does allow for it to be separately reported.”