Urology Coding Alert

The key: Pay attention to indicators 1 and 0 to prevent denials and capture payment The hardest hit codes in the National Correct Coding Initiative version 12.0 edits are the new injection codes, which NCCI now bundles with most urological services and procedures. Good news: You’ll be able to use a modifier to unbundle some--but not all--of the code pairs that took effect Jan. 1. New Drug Administration Codes Mean New Bundles The newest set of edits bundles the following drug administration codes with most column 1 urinary system codes, column 1 male genital system codes, and column 1 female genital system codes, says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook:

• 90760--Intravenous infusion, hydration; initial, up to 1 hour

• 90765--Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

• 90772--Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

• 90774--…intravenous push, single or initial substance/drug

• +90775--…each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure). Although the injection code bundles are significant and important because they limit the drug administration services you can report with major surgical procedures, urology coders expected the edits, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. Don’t Report Anesthesia Separate From Renal Ablation NCCI 12.0 bundles the column 2 codes for injections and intravenous therapy (36000, 36410, 37202) and local anesthetic codes (62318, 62319, 64415-64475) into new 2006 codes 50250 (Ablation, open, one or more renal mass lesion[s], cryosurgical, including intraoperative ultrasound, if performed), 50382-50389 (renal pelvic catheter codes) and 50592 (Ablation, one or more renal tumor[s], percutaneous, unilateral, radiofrequency).

Note: The column 2 codes have a modifier indicator of “1,” which means you can report both codes using a modifier, such as modifier 59 (Distinct procedural service), under specific clinical circumstances.

The Jan. 1 round of edits also bundles +69990 (Microsurgical techniques, requiring use of operating  microscope [list separately in addition to code for primary procedure]) into the renal ablation and pelvic catheter codes (50250, 50382-50389 and 50592). Code 69990 has a modifier indicator of “0,” so you can never report this code separately when billing codes 50250, 50382-50389 or 50592.

NCCI 12.0 makes clear that as indicated in its CPT Codes definition, 50250 includes ultrasonic studies 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation), 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, [...]