Cci 16.2: Halt Routinely Coding Indwelling Ureteral Stent Insertions

Round three of the Correct Coding Initiative (CCI) edits 16.2 went into effect on July 1

, 2010. This time, CMS CCI edits will potentially wreak havoc on your indwelling ureteral stent reimbursement.

There are 16,843 new edit pairs, bringing the total number of active pairs to 653,718. Here are some changes that will impact your urology practice. The biggest change for your practice will be the bundling of column 2 code 50605 into all ureteral surgical codes and all urinary diversion procedure codes. The just-in CCI edits indicate that CPT code 50605 added to the above particular procedure codes wont be a reimbursable service.

But with the new bundling edits noted above, 50605 will only be paid when appended with modifier 59, and only if specific criteria for use of modifier 59 are met. You should not bill CPT code 50605 routinely.

The latest CMS CCI edits also ties J0670 into injection code 51600, urethral catheterization codes 51701-51703, irrigation and instillation codes 51700 and 51720, aspiration of bladder codes 51100- 51102, prostate biopsy code 55700, in addition to several additional urological codes. The modifier indicator for these bundles is 1 also. These bundles reinforce the general Medicare coding policy that anesthesia provided by the attending doctor/surgeon whether it be topical or local infiltration is not a reimbursable service.

For more updates on the CCI 16.2, sign up for a one-stop medical coding guide. When you sign up for one, you will get reimbursement tools like CCI edit alerts thatll help you in your CCI coding.

by: James Article

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