Urology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

 

Answer: The short answer is: a) code 57160* is a starred surgical procedure because it is simpler than most other surgical procedures, and b) you cannot bill for E/M services with starred procedures such as 57160 precisely because they are simpler.

Starred procedures (those modified in the CPT manual with an asterisk) were created for that small group of codes that involve a readily identifiable surgical procedure but include variable preoperative and postoperative services, such as incision and drainage of an abscess, injection of a tendon sheath, manipulation of a joint under anesthesia, and dilation of the urethra.

Because of this, the usual surgical package concept does not apply. A surgical package comprises the listed surgical procedures covering the operation per se, local infiltration, metacarpal/digital block or topical anesthesia when used, and normal, uncomplicated follow-up care, according to the Surgical Guidelines.

For the E/M situation, the preoperative procedure gets starred when [it] is carried out at the time of the initial or established patient visit involving significant identifiable services, the appropriate visit is listed with the modifier -25 appended in addition to the starred procedure and its follow-up care, according to the CPT 2000 guidelines.

The preoperative procedure also is starred when [it] is carried out at the time of an initial visit [new patient] and this procedure constitutes the major service at that visit, procedure number 99025 is listed in lieu of the usual initial visit as an additional service.

It is important to note that starred procedures can be billed with other services, but only if they are not considered a part of the other service. Insurers may deny claims for fitting and insertion of a pessary if they consider it to be part of a larger surgical procedure. However, if fitting and insertion is unrelated to the other procedure, it can be billed separately.

This concept also applies to a question recently posed to Urology Coding Alert by Caroline Smith-Warfield, a billing supervisor in New Jersey. She asks whether code 52332 (cystourethroscopy, with insertion of indwelling ureteral stent) with modifier -59 or -51 could be billed with code 52005 (cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service).

In this case, procedure 52005 is considered a routine part of the more comprehensive procedure if done at the same session. If performed at different sessions on the same day, 52005 can be billed with the
-59 modifier.

A similar situation can arise with stone manipulation and stent placement. Frequently, a temporary stent is placed to facilitate stone manipulation and is removed at the end of the procedure. In this case, the stent is considered part of the manipulation and can not be billed separately. At times, however, a permanent double J stent is placed at the time of manipulation. In this case, because the stent is performing a function beyond the stone manipulation procedure, it can be billed separately. For significant, identifiable procedures are services that normally are not performed on the same day by the same physician, the -59 modifier should be used.