Urology Coding Alert

Heads up: You won’t be able to use a modifier to break the bundles The National Correct Coding Initiative (NCCI) will help you clean up your ureterectomy coding with edits that take effect April 1. NCCI Edits version 12.1 bundles 50650 into several urology procedure codes, including 50545-50548, to make sure you aren’t double-dipping.

The new edits solidify how coders should and shouldn’t use 50650 (Ureterectomy, with bladder cuff [separate procedure]), coding experts say.

“Code 50650 has a separate-procedure designation on it, which means if it is performed with any other service in that area, it should not be billed out,” says Christopher Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, coding instructor and consultant for Orion Medical Services in Eugene, Ore. “I know people have been trying to do it anyway, and I think that the NCCI edits are just putting a lock on it ... now it’s very clear and in black and white.” NCCI 12.1 Targets Cystectomies Thanks to NCCI, after April 1 you’ll be faced with the inability to report a ureterectomy with several other urology procedures, such as ureterocalycostomies and cystectomies. NCCI is placing a “0” modifier on new bundles between 50650 and multiple ureter surgeries (50660, 50740-50940, 50947, and 50948). Version 12.1 also bundles 50650 with cystectomy codes 51550-51597.

“The major impact of the 12.1 NCCI edit on our urologists is the bundling of the open ureterectomy (50650) with the cystectomy codes (51550, 51555, 51570, 51575),” says Trudie Galan, CPC, senior urology coder for Healthcare Information Services in Willowbrook, Ill. The cystectomy codes are the only codes in these new edits that leave urology coders without an option for reporting both a ureterectomy and a cystectomy, Galan adds.

If your urologist performs a cystectomy, it already includes the removal of the lower ureter adjacent to the bladder, and you shouldn’t bill extra for that, says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook.

Therefore, the April NCCI edits will ensure correct coding and eliminate double-dipping since the lower ureterectomy is part of the cystectomy procedure. ‘0’ Means You Can’t Break the Bundle When your urologist performs a nephrectomy and a ureterectomy, you’ll have to be careful which codes you use to report his work. After April 1, you’ll have to take note of new and revised bundles between 50650 and certain nephrectomy procedure codes.

NCCI version 12.1 is changing the modifier indicator on several 50650 bundles from “1” to “0.” This means that you won’t ever be able to use a modifier to separately report 50650 with the following [...]