Urology Coding Alert

The latest CCI targets a large number of urology surgical codes

With more than 10,000 changes, you could spend hours weeding through the latest round of Correct Coding Initiative (CCI) edits. But we've already done the deciphering for you. Take a look at the urology edits and deletions you need to incorporate into your coding this year.

Code Just 1 Ablation Procedure

CCI has bundled new code 50593 (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy) into open ablation code 50250 (Ablation, open, one or more renal mass lesion[s], cryosurgical, including intraoperative ultrasound, if performed) and laparoscopic ablation codes 50541 (Laparoscopy, surgical; ablation of renal cysts) and 50542 (... ablation of renal mass lesions[s]). These are mutually exclusive edits with a modifier indicator of 1, which means you can bypass the edit with a modifier under appropriate clinical circumstances.

Reasoning: This edit makes sense because you wouldn't do a percutaneous ablation at the same time you would do an open or laparoscopic ablation, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis. "They would probably be done in different settings, but never on the same day."

Home In on HoLEP Edits

CPT 2008 offers you a long-awaited code for the laser enucleation of the prostate technique followed by prostatic adenoma morcellation to remove it from the bladder -- or HoLEP procedures (52649, Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]). CCI 14.0 promptly bundles this code with a multitude of other urology procedure codes.

Column 1 code 52649 is mutually exclusive with many prostatic procedures for benign prostatic hyperplasia (BPH), including column 2 codes 52450 (Transurethral incision of prostate) and TURP codes 52612-52640 (Transurethral resection ...).

How it works: Comprehensive/component edits describe bundled procedures. That is, CMS considers the code listed in column 2 as the lesser service, which is included as a component of the more extensive column 1 procedure.

More edits: CCI also bundles column 1 code 52649, with column 2 codes 51040, 51102, 52001, and 52005-52240, all with a 1 modifier indicator. Then, CCI bundles column 1 code 52649 with column 2 codes 51700, 51701-51703, 52000, 52276 (internal urethrotomy), 52281 (cystoscopy and urethral dilation), 52400-52500, 52601, 52647-52648, and 53600-53665 -- all with a 0 indicator, which means you cannot bypass the edits, regardless of the circumstances.

Additionally: CCI also considers column 1 codes 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing) and 55873 (Cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]) mutually exclusive with column 2 code 52649. These edits have an indicator of 1.

Good news: These edits will rarely hamper your 52649 coding, experts say. "These edits are consistent with edits on other laser therapies of the prostate," Hause adds. The HoLEP procedure indicates a specific technique for performing laser prostatic surgery, and these new edits are similar to ones CCI placed on the Holmium ablation of the prostate (HoLAP) procedure.

There Are More Than Additions and Deletions

Bladder study code +78730 (Urinary bladder residual study [list separately in addition to code for primary procedure]) using radioisotopes does a column swap and jumps to column two, meaning that 60 E/M codes that CCI formerly bundled into 78730 are now the primary codes, so carriers will deny 78730 if you bill it with the E/M services.

Possible rationale: "It looks like it costs less for Medicare to pay for 78730 versus the exam," says Tina Lee, CPC, coding specialist with Urology Associates of Central California in Fresno. Indeed, 78730 has a relative value of 1.98, whereas 99215 is worth only 1.38 relative value units (RVUs).

Bladder Aspiration Edits Return

You'll have to incorporate several new bundles into your bladder aspiration coding, thanks to CCI 14.0. CCI bundles column 1 codes 51100-51102 (Aspiration of bladder...) with many column 2 codes, including 36000, 36410, and 37202 (intracaths), and injection codes 62318-62319, 64415-64417, 64450, 64475, 90760, 90772, and 90774-90775. All have an indicator of 1. These edits mirror the past edits that existed between the old bladder aspiration codes (51000-51010) and the above CPT codes, Hause says.

Also: You won't be able to report +69990 (Micro-surgical techniques, requiring use of operating microscope [list separately in addition to code for primary proce-dure]) with the new bladder aspiration codes. CCI put a 0 modifier indicator on this bundle, preventing you from ever unbundling the codes.

Watch these other edits as well:

• If you code for a urogynecologist, you should know that CCI made column 1 hysterectomy codes 58152-58240, 58262-58294, and 58552-58554 mutually exclusive with several of the new laparoscopic total abdominal hysterectomy codes (58570-58573) -- with a modifier indicator of 1.

• Many of the nephrectomy codes (50220-50240) now bundle with the new thoracentesis code 32421 and the new thoracotomy tube placement codes 32422 and 32551. These new bundles indicate that postoperative tube drainage of the pleural cavity after a thoraco-abdominal nephrectomy is part of the surgical approach, and you should not bill separately for the drainage. On the other hand, these edits have a 1 indicator, meaning that if you place a thoracotomy tube postoperatively in the recovery room but on the same day as the nephrectomy, you may report the nephrectomy with 50230 and the tube placement with 32551, appending modifier 59 (Distinct procedural service) to 32551 to indicate a separate procedure.