Part B Insider (Multispecialty) Coding Alert

Harder to bill for dilation of urethral stricture or stenosis separately

CPT code 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female) became a component of several other cystourethroscopy codes.
 
The column 1 codes with this code are 52007-52010, 52214-52234, 52250-52277, 52282, 52290-52300, 52305, 52317-52330, 52334-52510, 52606, 52614, 52620-52640 and 52700. You can't use a modifier to override these edits.

52281 was already a component of 52235 (Cystourethroscopy with fragmentation of ureteral calculus) and 52240 (cystourethroscopy, with fulguration...LARGE bladder tumors).

Often, coders bill 52281 separately for urethral dilation along with procedures like a cystoscopic examination, retrograde pyelogram and urethral stent placement for a urethral stone.

"There are a lot of commercial carriers that already lump it into a lot of the other codes," says Terry Vennell, billing manager for Knight, Boline & D'Amico in Harrisburg, Penn. "I'm not surprised that it's been included in a lot of them." Her practice doesn't bill 52281 frequently, "but I could see where someone would want to bill it separately."

"If they have to do a urethral dilation while they're doing something else, like a cystoscopy with full duration or cystoscopy with biopsy, I don't bill separately for the 52281," adds Vennell.

"I think they would typically do that with other procedures," says Laura Siniscalchi, a senior consultant with Deloitte and Touche in Boston. "That'll be an issue" for coders, she adds.

Separately, 76000 (Fluoroscopy, up to one hour) and 76001 (Fluoroscopy, more than one hour) became components of cystourethroscopy codes 52005-52007, 52310-52346 and 52351-52355. You can use a modifier to override these edits.

Separately, axillary lymphadenectomy code 38740 became a component of mastectomy code 19240. Chemotherapy code 96530 became a component of pump implantation codes 62367 and 62368. Muscle and range of motion testing codes 95831 and 95833 both became components of 95834, while 95832 became a component of 95833.

Needle oculoelectromyography code 92265 became a component of needle electromyography code 95868 (cranial nerve supplied muscles, bilateral). And ambulatory blood pressure monitoring code 93788 (Scanning analysis with report) became a component of 93784 (Recording, scanning analysis, interpretation and report).