Version 16.3 of the National Correct Coding Initiative (CCI) edits initiated many new edit pairs on Oct. 1. You’ll need to get to know new edits affecting your small and large bowl injury repairs, open ureterotomy stentings, and diagnostic laparoscopy coding.
Count Bowl, Splenic Injury Repairs With Main Surgery
If your urologist has to perform a small or large bowl repair for an intestinal injury that occurs during an open urological or urogynecological procedure, you’ll likely be facing a new CCI edit dilemma.
CCI bundles column 2 codes 44602 (Suture of small intestine [enterorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation), 44603 (… multiple perforations), 44604 (Suture of large intestine [colorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture [single or multiple perforations]; without colostomy), and 44605 (… with colostomy) into many of the procedures in the 50010-57280 range.
Silver lining: These edits have a modifier indicator of “1,” which means you can bypass the edits in some clinical circumstances, using a modifier such as 59 (Distinct procedural service). “These bundles indicate that a repair of an inadvertent small or large bowl injury occurring during urological or urogynecological surgery will be included in the primary procedure under most circumstances and should not be billed separately,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “If such an injury does occur and is repaired, the surgeon should check CCI, version 16.3 edits to determine if their primary procedure is involved in these edits.”
If, during a urological procedure such as a difficult left nephrectomy, an inadvertent splenic injury occurs, resulting in an open splenectomy (38100, Splenectomy; total [separate procedure]), a partial splenectomy (38101, … partial [separate procedure]), or a laparoscopic splenectomy (38120, Laparoscopy, surgical, splenectomy) you may not be able to separately report these corrective procedures.
CCI 16.3 now bundles these three codes into various urological procedures, such as 50010 (Renal exploration, not necessitating other specific procedures), 50365-50380 (renal transplantation procedures), and 50543-50548 (laparoscopic nephrectomy procedures). These edits do have a modifier indicator of “1.” “In general, however, if an intraoperative splenic injury occurs resulting in a splenectomy, total or partial, the CPT codes for these procedures – 38100, 38101, and 38120 – are bundled into and should not be billed in addition to the primary procedure(s) noted above.” Ferragamo explains.
“Although intestinal repairs and splenectomy for inadvertent intraoperative injuries are now bundled into many operative procedures, if the repairs do take a significant amount of operative time and effort, I would bill for the intestinal repairs or splenectomy adding modifier 59 and bypassing the above edits. An accurate, comprehensive and detailed operative report and a fully documented covering letter in layman’s terms may be necessary to ensure payments for these bundled edits bypassed with modifier 59,” Ferragamo states.
Learn Even More Ureterotomy Bundles
In the recent past, CCI has bundled 50605 (Ureterotomy for insertion of indwelling stent, all types) into several ureteral implantation and ureteral injury repair codes. Version 16.3 adds even more codes to the list, including: 50300-50380, 50400-50405, 50545-50548, 50610-50600, 50700-50725, 50830-50840, 50860, 50920, 50947- 50948, and 51800-51992.
“These edits indicate that 50605 should not be billed in addition to the above CPT codes,” Ferragamo says. These edits have a modifier indicator of “1,” so you can override the edits with a modifier, usually 59, under appropriate clinical circumstances.
Count Diagnostic Laparoscopic Exam With Main Procedure
You will now need to include diagnostic laparoscopies (49320, Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) when your urologist performs, with all column 1 laparoscopic operative procedure codes. CCI 16.3 also bundles 49320 into the following codes:
- 50785-50840
- 51020-51080
- 51500
- 54560
- 54650
- 55535
- 55560-55580
- 55815-55865
- 57270-57280
All of these edits have a modifier indicator of “1.”
Don’t miss: You’ll also find that CCI 16.3 tells you that abdominal surgery for an undescended testicle – 54560 (Exploration for undescended testis with abdominal exploration and 54650 (Orchiopexy, abdominal approach, for intraabdominal testis [e.g., Fowler-Stephens]) – “will now include (bundle) the diagnostic laparoscopic examination performed simultaneously with the open testicular procedures indicated above,” Ferragamo warns. “However, remember if the laparoscopic examination leads the urologist to perform either of the above testicular procedures, I would consider the diagnostic laparoscopy a billable and payable service. In this case I would bill for both and suggest adding modifiers 59 and 58 (Staged or related procedure…during the postoperative period) to 49320 to bypass the edit and indicate the laparoscopy as a staged procedure,” he adds.
Stay tuned to Urology Coding Alert for all your 2011 medical coding updates.