subject: Urethral Dilation Coding Hit Hard by CCI 16.1 Edits [print this page] Urethral Dilation Coding Hit Hard by CCI 16.1 Edits
Just when you are finally getting a handle on all the 2010 coding changes, here are the second round of the CCI correct coding edits. The latest version will tie your hands when coding many common urology procedures, including prostrate biopsies and urethral dilations.
This time there are 78 edit pair additions and two edit pair deletions. Take a look at these changes so that you get proper reimbursements for your urologist's services.
Stay away from biopsy with several prostrate procedures
Now you cannot report prostrate biopsy codes 55700 with 52630. Your payer will pay you for 52630 but not for the biopsy codes, and you cannot make use of a modifier to segregate these new edits.
Be wary of multiple urethral edits
Urethral coding has been hit really hard by the CCI edits. So now you'll have to consider 53605, 53620, and 53621. The good part is while you cannot override a part of these edits, few bundles have a modifier indicator of "1". Say for example, CCI bundles 53601 and 53605 but assigns a "1" indicator, meaning, if a patient having a dilation of a urethral stricture or bladder neck under general or spinal anesthesia in the morning may then later on during the same day at a separate encounter have a subsequent urethral dilation under local anesthesia. You can go for both procedures by reporting 53605 and 53601-59.
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