Urology Coding Alert

You’ll find you can’t report mesh placement with even more procedures.

By the time fall rolls around, the Correct Coding Initiative (CCI) usually has fewer updates to the fourth update of the year. This year is no exception; however, there are edits involving urogynecology and laparoscopic urological surgery codes that you’ll need to add to your repertoire to keep your coding on the up and up.

“There are 5,247 new edit pairs, bringing the total to number of active edits to 1,340,210,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. Read on to see which of those edits will affect your coding for the rest of 2014. 

Skip Modifier with 49400 Bundles

You will find that as of the Oct. 1, 2014 implementation, CCI 20.3 bundles 49400 (Injection of air or contrast into peritoneal cavity [separate procedure]) into all of the following urological and gynecological procedure codes: 

• Laparoscopic kidney procedures 50541-50548
• Laparoscopic bladder procedures 51990-55199
• Laparoscopic orchiopexy procedures 54690-54692
• Laparoscopic spermatic cord procedure 55550
• Laparoscopic prostatectomy procedure 55866
• Laparoscopic vaginal procedures 57423-57426. 

Code 49400 represents a procedure that “is the basic initial part of all laparoscopic and robotic procedures,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. 

Understand ‘separate procedure’: “When a CPT® code includes a parenthetic note stating ‘separate procedure,’ that means you should use the code only when the provider performs the service as a stand-alone procedure,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. “If the surgeon performs the procedure during the same operative session at the same site as a primary procedure, you should not report a ‘separate procedure’ code, because the primary procedure includes the service.”

With that logic in mind, you can see that if your urologist injects air or contrast into the peritoneal cavity as part of any of the listed laparoscopic procedures, you should not separately bill for the air or contrast. “In fact, injecting air or contrast into the peritoneum is a typical step that is part of most laparoscopic procedures,” Bucknam reiterates.

Beware: These edits all have a modifier indicator of “0,” which means you can never override the CCI edits and bill 49400 with any of the above laparoscopic or robotic procedures.

Update Your Mesh Bundles

If your provider performs urogynecology procedures, you will want to watch out for new bundles between vaginal mesh placement code +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]) and the following codes: 

• 57000 — Colpotomy: with exploration
  
• 57100 — Biopsy of vaginal mucosa; simple (separate procedure)
  
• 57105 — … extensive, requiring suture (including cysts)
  
• 57210 — Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical). 
  

The bundles with 57000 and 57100 have a modifier indicator of “0,” so you cannot use a modifier to report both codes. However, the 57105 and 57210 bundles have a modifier indicator of “1,” which means you can use a modifier such as modifier 59 (Distinct procedural service) to report both codes in certain clinical scenarios. 

CCI 20.3 also bundles 57268 (Repair of enterocele, vaginal approach [separate procedure]) with 57105 and 57210. These two edits have a modifier indicator of “1.” 

Additionally, you can no longer report 57300 (Closure of recto-vaginal fistula; vaginal or transanal approach) with 57000, 57105, or 57150 (Irrigation of vagina and/ or application of medicament for treatment of bacterial, parasitic, or fungoid disease ). The 57000 and 57150 bundles with 57300 have a modifier indicator of “0,” whereas the 57105 bundle has a modifier indicator of “1.” 

“Some of these urogynecology CPT® bundled codes can be billed together if allowed by the specific modifier indicator and under the proper clinical circumstances,” Ferragamo explains.