Generally modifier 59 will rescue your reimbursement.Simply while you had been getting a grasp on all 2010 coding adjustments, the spherical two of the Right Coding Initiative (CCI) edits went into impact on April 1. This has tied the palms when coding many widespread urology procedures, together with prostate biopsies and urethral dilations.Heads up: The most recent model covers 2,054 new energetic pairs and 1,947 modifier adjustments, as laid down by Frank D. Cohen, MPA, MBB, senior analyst with MIT Options Inc. in Clearwater, Fla.Michael A. Ferragamo, MD, FACS, scientific assistant professor of urology on the State College of New York at Stony Brook says, “For urology, there’ll be 78 edit pair additions and two edit pair deletions.” To see to it that you just receives a commission proper in your urologist’s providers this quarter, check out these key adjustments.Bid goodbye to biopsy with a number of prostrate procedures
You possibly can not go for prostate biopsy codes 55700 (Biopsy, prostate; needle or punch, single or a number of, any method) or 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, together with imaging steerage) with 52630 (Transurethral resection; residual or re-growth of obstructive prostate tissue inclusive of management of postoperative bleeding, full [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, as well as internal urethrotomy are covered]). Your payer will get you the pay for 52630, nevertheless, deny the biopsy codes and you’ll’t go for a modifier to separate these new edits.Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind laments, “I’ve no primary issue with the bundling of 55700 and 52630.” In accordance with Kater, her urologists carries out a great variety of prostrate biopsies transrectally and 55700 is what she makes use of because the descriptor says “any approach”. While you’re finishing up two separate procedures utilizing two totally different approaches, how can they be bundled?Here is the silver lining: CCI additionally bundles 55705 (Biopsy, prostate; incisional, any method) into 52630, nevertheless the edit carries a “1” modifier indicator. As such, you possibly can break that bundle if scientific circumstances demand separate reporting.Furthermore: With impact from April 1, transurethral resection of the prostate (TURP) code 52601 (Transurethral electrosurgical resection of prostate, together with management of postoperative bleeding, thorough [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are covered]) and laser prostatectomy codes (52647-52649) are mutually unique with saturation biopsy of the prostate underneath anesthesia (55706).
The 52601/55706 and 52648/55706 bundles have a modifier indicator of “0”; as such you possibly can by no means invoice these codes collectively. In accordance with Ferragamo, opposite to this, each the 52647/55706 and 52649/55706 bundles have a modifier indicator of “1”, which implies you possibly can go for the codes collectively underneath particular scientific circumstances utilizing a modifier like modifier 59 (Distinct procedural service).You will discover prostate biopsy listed as column 2 code (55706), forming mutually unique edits with the next column 1 codes:Transurethral destruction of prostate tissue (53850-53852), Prostatectomy (55801-55845, 55866), and Cryosurgical ablation of the prostate (55873).The modifier indicator for all of the talked about edits is “1”. You possibly can break the bundles when scientific circumstances warrant.