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Urology Coding Alert

NCCI Update:
Reporting Radioactive PVR Studies and Cystos Separately? Not Anymore

Watch for new coding edits designed to stop 'double-dipping' for post-void residual studies  If you're coding urinary bladder residual studies using radioactive materials separately from catheterization or cystourethroscopy codes, NCCI would like a word with you. That word is "stop."
The second set of National Correct Coding Initiative edits for 2005, version 11.1, bundles nuclear medicine service code 78730 (Urinary bladder residual study) into 46 urinary system codes in order to counteract "misuse" of that code. Translation: Coders have been separately reporting 78730 inappropriately, and NCCI is putting a stop to it. Other new coding edits will affect how you code transvaginal urethrolysis.
Reminder: These NCCI edits went into effect April 1, 2005. Include 78730 in Cysto, Cath Procedures NCCI Edits version 11.1 mandates that you consider 78730 an intrinsic part of 151 procedures, including urinary system procedures, echocardiography procedures and other radiology procedures. Medicare has assigned modifier indicator "0" to these code pairs, meaning you are not allowed to report 78730 separately along with any of the comprehensive codes, even if you append a modifier, says Dolly Perrine, CPC,   CCS-P, coder and biller for Bend Urological Associates in Bend, Ore.
Other PVR tests - including bladder scans (76775, Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) and urodynamics (51725-51798) - now also include 78730, according to NCCI.
NCCI 11.1 also bundles 78730 into most of the E/M codes from 99201 to 99350. These bundles are marked with modifier indicator "1," which means you can append a modifier to break the bundle when the documentation indicates two separate services.
Why? CMS is trying to stop "double-dipping" for PVR, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. "Most of the comprehensive codes are procedures where a catheter is inserted or a cystourethroscopy is performed, by which a PVR can be obtained as well," Hause says. Catheter insertion is already considered an intrinsic part of the cysto codes, he says.
Despite the number of codes affected, this edit does not necessarily have earth-shattering implications for your practice, says Bruce Hammond, CRA, CNMT, COO of Diagnostic Health Services in Texas. "[Procedure] 78730 is very uncommon," he says. "The bulk of these are done at children's facilities for follow-up to recurrent urinary tract infections (UTI), most often in girls."
"Urologists will rarely perform this procedure (78730) to determine post-voiding residual urine volume, as this is a nuclear medicine study necessitating radioactive materials and special equipment for radioactive scanning," says Michael A. Ferragamo, MD, FACS, clinical [...]

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