Urology Coding Alert

Tip: Check the edits before separately reporting 69990 As soon as CPT Codes adds new codes, the National Correct Coding Initiative (NCCI Edits ) is right there to limit how you can use those codes. Let our experts guide you through the myriad of urology bundles that you’ll face during the first quarter of this year. Use Add-On Code 38747 for Full Payment As of Jan. 1, you won’t be able to report lymphadenectomy codes 38562 (Limited lymphadenectomy for staging [separate procedure]; pelvic and para-aortic) and 38564 (... retroperitoneal [aortic and/or splenic]) when your urologist performs a radical nephrectomy (50230, nephrectomy ... radical, with regional lymphadenectomy and/or vena caval thrombectomy) and an extended lymphadenectomy.

No modifier help: These new bundles have modifier indicator of “0,” meaning that these edits cannot be bypassed or broken with any modifier.

Solution: Because of these edits, if your urologist does perform an extended lymphadenectomy at the time of the radical nephrectomy, you should report 50230 and code +38747 (Abdominal lymphadenectomy, regional ...) to indicate that the physician performed an extended node resection, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

Tip: Since 38747 is an add-on code, you do not need to add modifier 51 (Multiple procedures) to your claim. Update Your Guidance Code Choices NCCI 13.0 targets ultrasonic guidance code 76998 (Ultrasonic guidance, intraoperative) and fluoroscopic guidance code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). The latest set of edits bundles both 76998 and 99002 into many percutaneous renal procedures (50021, 50080, 50081, 50382-50387, 50392, 50394-50398) and one open renal procedure (50250).

In addition, 77002 is now bundled into two cystostomy tube change procedures: 51705 and 51710.

Difference: These bundles carry a modifier indicator of “1,” which means you can override the edits by reporting both codes with a modifier, such as modifier 59 (Distinct procedural service), appended to the bundled code, and expect to be paid for both under the proper clinical circumstances.

When your urologist performs a microwave treatment of the prostate (53850, Transurethral destruction of prostate tissue; by microwave thermotherapy), you’ll no longer be able to separately report 52510 (Transurethral balloon dilation of the prostatic urethra).
 
Reminder: This bundle carries a modifier indicator of “0.” The “0” indicator means you may not use any modifiers to unbundle the edit under any circumstances, so you’ll no longer be paid separately for the dilation, Ferragamo says. Don’t Count on Modifiers With 55875 Bundles New code 54865 (Exploration of [...]