Coder's Cranium

Calculi Coding: Capture Full Pay for Multiple Fragmentations

When your urologist fragments more than one stone located in two different locations within the urinary tract during one operative session, the proper coding might leave you scratching your head: Can you ever report both procedures? If you can, how do you sequence the codes? Tackle these tough questions by reviewing a sample scenario.

Your urologist performs a ureteroscopic laser lithotripsy of a left ureteral stone and lithotripsy of a bladder stone. How should you code these procedure performed during one operative session?

Separately Report Procedures Based on Anatomy

Depending on where the stones are in the urinary tract, you may be able to separately report and be paid for multiple fragmentation procedures during the same session. For a ureteroscopic fragmentation of a ureteral or renal pelvic stone your urologist performs, you’ll report 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]). Remember that 52353 applies to “any type of fragmentation, whether you use a Holmium laser, a Candela laser, a mechanical lithotripsy, or an ultrasonic lithotripter,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. If your urologist also fragments a bladder calculus during the same session, your coding will then depend on the different and separate anatomical location of the stones. Therefore, in the sample scenario, you can separately report those procedures. “We are dealing with two separate portions or parts of the urinary tract – a ureteral stone and a bladder stone,” Ferragamo explains.

According to the Correct Coding Initiative (CCI), codes 52317 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm]) and 52318 (…complicated or large [over 2.5 cm]) are bundled with 52353. Because both bundles have a...

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November 23, 2010
CCI

CCI 16.3: Incorporate Injury Repair, Laparoscopy Bundles to Stay Compliant

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)...

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November 14, 2010
Hot Coding Topics

CPT 2010 Update: Urogynecology Coding

Remember, supervision requirements still apply to new codes. CPT 2010 brings some big changes to urogynecology coding. Your urodynamics coding — and income — changes drastically as of Jan. 1. Get to Know These 3 New Complex Cystometrogram Codes You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes: • 51727 — Complex cystometrogram (ie, calibrated [...] Related articles:

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January 5, 2010
CPT 2010 / Hot Coding Topics

Urology CPT 2010: 3 New Codes, 2 Deletions Change Your Urodynamics Coding

Urodynamics income will go down by half, experts calculate. You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes: • 51727 — Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique • 51728 — … with voiding pressure studies (ie, bladder voiding pressure), any technique • 51729 — … [...] Related articles:

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November 21, 2009