Get pointers on ways to avoid claim denials when
you use this new code with other urological procedure codes.
The latest round of CCI edits effective April 1, 2014,
does some cleanup, bundling new 2014 codes with existing codes. So even though your urology practice can take
it easy this time, it still needs to focus on a new code – 52356. Here are some helpful tips you need to
know to avoid claims rejections when you use the code 52356 along with other urological procedure codes.
Avoid Ureteroscopic Stone and Lithotripsy Coding
The latest edits bundle the new code 52356 with column 1
codes 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy,
with or without dilation, endoscopy, lithotripsy, stenting, or basket
extraction; up to 2 cm) and 50081 (... over 2 cm). The bundling
edit can be overridden (since it has a modifier indicator of “1”) most likely
with modifier 59 and both the codes can then be billed and reimbursed. If your urologist is unsuccessful in
breaking up the stone endoscopically and he must then perform the ureteroscopic procedure,
you may use modifier 59 to override this bundling.
When both procedures are used to
remove the stone totally, bill 50080 or 50081 and 52356 during this same
encounter. This may be an unusual scenario, but both procedures may be
necessary and even the use of modifier on 52356 to get the reimbursement for the
latter procedure.
Bundling Between 52356 and Column 2 Codes
Additionally, the April edits also
create bundling between 52356 and the following column 2 codes: 50561, 50961, 50980, 52320, 52330, 52352, and 52353. These edits
too have a modifier indicator of “1”, allowing unbundling of these pairs under
some clinical circumstances.
Here’s an example to help your understanding: You may use modifier 59 to break the bundle between 52356 and 52352 or 52353
if your urologist performs the 52356 procedure on the right side of the patient
and the 52352/52353 procedure on the left.
When a calyceal stone has also been removed at the same encounter
from the same kidney when a renal pelvic stone has also been fragmented and a
JJ stent placed, you can bill code 52352-59-76.
Note: The bundling of 52352
with 52356 continues the previous similar bundling of these two codes 52353 and
52352, when 52352 is not supposed to be billed with 52353 while treating the
same kidney stone.
If you’re not careful and up-to-date, you could
face claim rejections. Ensuring you take the most appropriate bundling
decisions for your urology practice and avoiding claim denials is not easy, but
having a good SuperCoder CCIchecking tool (that alerts you with color-coded messages) can reduce your concerns
by half!
