# 52310-bilateral?



## efuhrmann (Apr 27, 2011)

My software tells me that cpt code 52310(cystourethroscopy with stent removal)cannot be billed with mod 50.  Can I assume this cannot be performed bilaterally(which my doctor is trying to bill)?


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## kandigrl79 (Apr 28, 2011)

I'm curious about this too.  I have a case where 52310 was documented as being performed bilaterally, but it's kicking out for the same reason that it cannot be billed with modifier 50.  How should you bill this bilaterally? or can you?


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## kandigrl79 (Apr 28, 2011)

Hey Elizabeth,
I found this information on supercoder.com, pay close attention to the last paragraph, hope this helps:
On a straight cystourethroscopy, Medicare and CPT agree: Do not use modifier -50. Cystourethroscopy literally means “looking into the bladder.” Therefore, it is not appropriate to append modifier -50 to a cystourethroscopy code that has no other procedure included, such as a ureteroscopic procedure, because urologists can look into only one bladder. Both CPT and Medicare rules agree that 52000 (cystourethroscopy [separate procedure]) cannot take modifier -50 because it cannot be performed bilaterally. 




Whether you use the phrase “inherently bilateral,” as CPT does, or simply view a cystourethroscopy as medically impossible to do bilaterally, the end result is the same: You cannot append modifier -50 to 52000 or to many other procedures. 




In fact, any cystourethroscopy code referring only to the bladder cannot take modifier -50, under either Medicare or CPT, says Jan Brunetti, CPC, coder for Urology Associates, a four-urologist practice in Newport, R.I. “That's because you're there anyway,” she says. “Don't try to bill bilaterally just because something is done on both sides of the bladder. That would really be stretching it.”




Other cystourethroscopy codes that neither Medicare nor CPT allows to be billed with modifier -50 include 52010, 52204-52285 and 52305-52318. These codes cannot be billed with modifier -50 because they are “inherently bilateral,” according to CPT. In other words, when you perform a procedure such as 52214 (cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands), the entire area is included. “There may be several bleeding points in the trigone,” says Michael A. Ferragamo, MD, assistant clinical professor of urology at the State University of New York, Stonybrook. “But still you can only bill 52214. You get no extra credit for fulgurating on both sides of the trigone.” 

*In another example, the urologist removes a foreign body from the bladder. Report 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) for this procedure. Even if there are two foreign bodies, do not append modifier -50, under either CPT or Medicare rules. Although removing two ureteral stents seems to be a clear case for modifier -50, neither Medicare nor CPT rules allow it on 52310. 

Tip: Ferragamo recommends coding 52315 (… complicated) for two stent removals. Likewise, use 52315 if you must remove multiple foreign bodies, as when seeds following brachytherapy are misplaced and end up in the bladder, or if you must remove multiple stones from the bladder.****so...I guess we should code 52315 if it's bilateral...


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## efuhrmann (Apr 28, 2011)

thank you for the thorough reply!!  Liz


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