Wiki Urology bundling issue

[martnel]

What other modifier than 59 could be use with these 2 codes: 52224 and 52005? Or should I code them with a 59? I do not code them both, but my administrator wants me too...... There are a few other cases too, this is just one example that we do not see eye to eye.

CCI Results

Check CCI relationships for all the following codes:

CCI Unbundle relationships exist - The first code listed is a Column 1 code; the second code listed is a Column 2 code.

Warning: These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation.
Code Description 52224 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy - Allowed
52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; - Allowed

 

[emcee101]

I agree with you that they should not be coded together under normal circumstances. Without reading your op note to see the reason why the 52005 was performed (which could provide valid reason to override the CCI bundle) I would not code for both procedures when performed together.

Simply because there is a modifier that will unbundle these codes does not meant that it should be used every time. To unbundle these, or any codes, there needs to be specific reasons to do so that are clearly justified in the operative report.

That said, if you're not familiar with them already, look into the 4 new "X{EPSU} HCPCS modifiers that CMS created for 2015 to further define the 59 modifier's role. Below is the link to their notification on these modifiers which should provide a decent base of understanding. Hope this helps!

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf

 

[martnel]

Thanks emcee101! I was just saying that once these X modifiers are in full swing, we don't even need to worry about 59 in these cases! There is in my opinion no reason to unbundle it, but then why do they say you can do it? Except for 59, there is no other modifier that I can think of to use?

 

[emcee101]

if you're going to use a modifier, I would agree that 59 or XS would be the correct modifier. I would use in on instances where the 52005 (74420 too?) was being done for a (documented) separate unrelated diagnosis than what the 52224 was being performed, i.e. bladder tumor for 52224 and ureteral stricture for 52005.