# cystoscopy at the time of hysterectomy??



## Babsss

Name of operation
lap bil sal-oop
Cystoscopy

I understand the hysterectomy codes, but there was a cystoscopy done after closing the incision of the lap surgery.  Then the cystoscopy was performed.

Op note 
patient had been complaining of lower abd pain as well as pelvic pain, and cysto was done to evaluate the bladder.  It did appear that she had multiple petechiae consistent with interstitial cystitis.  Both ureters were seen to efflux withou difficulty and once the bladder have been filled and drained, the procedure was then terminated.

The only code I see is the 52000-cystourethroscopy.

Would this be correct? It is a seperate procedure from the hysterectomy.
Thanks


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## Emmy1260

52000 is the correct code, with modifier added. 

When the cystoscopy is done only to inspect the bladder and ureters post procedure, multiple sources say no. 

If there is a dx code specific to the reason, then I would code it. 

Google 'coding cystoscopy with hysterectomy' for multiple sources.


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## Lbooth110

Does anyone know if this information is on the ACOG website. Or do you know where we can find the guidelines for billing a cystoscopy with a hysterectomy.  Just to see iff there are any problems with the bladder or ureters.

I looked this up in the CCI EDITS and a 58571 is not bundled with 52000 and vesa versa. 

Thank you for your help.

Lisa


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## OCD_coder

The 58571 and 52000 meet the criteria to bill separately, a modifier 51 would be correct appended to the 52000.  

First, the reason for the cystoscopy is due to abdominal pain and not to check the work of the lap surgery.  Second, the bladder and urethra are not considered contiguous per the modifier 59 criteria needed to support separate procedures performed at the same surgical session.

This from Society of Gynecological Oncology (SGO):
_Can you report a cystoscopy at the time of a pelvic procedure to make sure there is no injury to the ureters?

A cystoscopy performed routinely at the time of a surgical procedure is not separately reportable.  When procedures are done to "check" one's work, it is considered inherent in the procedure.  Additionally, there is not an ICD code that can be appended to support a clinical need for the service.  If there has been an injury to the ureters at the time of the surgery, then it would be appropriate to report the cystoscopy with the appropriate ICD code, such as hematuria._


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