Wiki Can 52001 and 52630 be unbundled?

[kmartinez]

Is it appropriate to unbundle CPT 52001 and 52630?

KAM

 

[pvacanti]

As long as the op note supports the unusual circumstance in coding both than you may append a modifier to unbundle to 2 codes. But there must be description documentation that the procedures where unrelated.

CCI Validation Results:

Code 52001 is a column 2 code for 52630 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 52001
CCI edit Rule:
Standards of medical / surgical practice


Note*: Always use modifier (if allowable) with column 2 code.

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, XU, 24, 25, 27, 57, 58, 59, 78, 79, and 91. Read about modifiers for CPT and HCPCS codes

 

[CodingKing]

[FONT=&quot]cystourethroscopy is included in 52630 according to the code description[/FONT]

 

[cgaston]

CCI Validation Results:

Code 52001 is a column 2 code for 52630 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 52001
CCI edit Rule:
Standards of medical / surgical practice


Note*: Always use modifier (if allowable) with column 2 code.

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, XU, 24, 25, 27, 57, 58, 59, 78, 79, and 91. Read about modifiers for CPT and HCPCS codes

Just because a modifier "may" be allowed does not mean you can throw a -59 modifier on and call it a day. There has to be an unusual circumstance beyond normal treatment as a reason to unbundle these. If the irrigation is done during the TURP it is considered part of the procedure.

If the irrigation is done for something outside of the TURP it might be separately payable but it would still need to be for something completely unrelated.

 

[NiteshlalKoyalkar]

Hi,
Information which you shared does not provide enough evidence to decide whether the services billed are actually sepearate and distinct .
please provide more details.

 

[pvacanti]

Just because a modifier "may" be allowed does not mean you can throw a -59 modifier on and call it a day. There has to be an unusual circumstance beyond normal treatment as a reason to unbundle these. If the irrigation is done during the TURP it is considered part of the procedure.

If the irrigation is done for something outside of the TURP it might be separately payable but it would still need to be for something completely unrelated.

@cgaston Yes I agree when I originally replied to the post it did not include my reasoning. Thank you