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Urology Coding Alert

News Brief:

CCI 7.2 Leaves Ureteroscopy Codes Free of Stent Bundles

Published on Wed Aug 01, 2001

When the ureteral stricture and ureteroscopy codes were changed to 52341-52355 in 2001, the Correct Coding Initiative (CCI) did not carry over any bundles for those codes (see related articles in Urology Coding Alert May and July 2001). CCI 7.2>, effective July 1, has fixed that problem with the bundling of 10 codes. However, stents (52332) are still not bundled with 52341-52355.
 
The following codes are now bundled into 52341-52355: 52000, 52005, 52351, 53080, 53660, 53661, 53670, 53675, 69990 and P9612.
 
If you perform a bundled procedure for a separate reason, you can bill it with modifier -59 (distinct procedural service). Under the current CCI, however, you need no modifier to bill 52332 with any of the codes in the 52341-52355 range.
 
Codes 76873 (echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) and 55873 (cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]), as well as 76872 (echography, transrectal) and 55873, are now mutually exclusive. You cannot bill them both in the same session. You can, however, unbundle them with modifier -59 on the lesser-paying code if done in different sessions, even if done on the same day. Code 55873 is new for 2001.
 
Medicare to Cover Sacral-Nerve Stimulation for Incontinence
 
Medicare will cover sacral-nerve stimulation for treatment of urinary incontinence, HHS Secretary Tommy G. Thompson announced June 29. CMS says the program memorandum is in development and will be issued within coming months. Some carriers already cover the procedure.
 
CPT 2002 will have two codes for sacral-nerve stimulation: 6456x for the implantation and 6458x for the incision. CPT now has no codes for sacral-nerve stimulation, but existing local medical review policies recommend codes for peripheral-nerve stimulation -- 64555 (percutaneous implantation of neurostimulator electrodes; peripheral nerve) for implantation and 64575 (incision for implantation of neurostimulator electrodes; peripheral nerve) for incision.
 
Medicare Covers Salvage Prostate Cyrosurgery
 
Effective July 1, 2001, Medicare considers salvage cryosurgery of the prostate medically necessary under certain circumstances and will pay for the procedure (55873, cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]). To qualify for reimbursement, patients must have failed a trial of radiation therapy and must meet one of the following conditions: stage T2B or below, Gleason score less than 9, or prostate specific antigen (PSA) less than 8 ng/mL. Code 55873 is still not payable after failure of therapies other than radiation.

Code 76000 Needs No Professional Modifier
 
As of July 1, CMS has notified carriers that the professional/technical component does not apply to 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]). Urologists typically bill 76000 with modifier -26 (professional component) because they perform only the professional component. The professional/technical component indicator in the Medicare Fee Schedule for 76000 has been changed from "1" (bill global without a modifier or components with either a -26 or -TC modifier) to "9" (professional/technical component does do not apply).
 
Payment will be much less for 76000, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver. As of July 1, the relative value unit for 76000 is 0.24, compared to 1.61 for 2001 and 1.64 for 2000. The program memoranda mandate that the carriers and intermediaries be fully implemented by July 1, 2001.
 
For more information, see HCFA's Program Memorandum AB-01-84 (June 4) and AB-01-59 (April 27).

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