Urology Coding Alert

Follow these expert tips to improve your claim approval process.

If you get frequently frustrated by urology coding obstacles that result in claim denials, you’ve come to the right place. We’ve put together some expert advice from Edna Maldonado, CPC, ACS-UR, AHIMA, ICD-10 Trainer, a seasoned professional in the field, who shared her valuable insights on how to tackle many common coding problems.

By avoiding the four mistakes discussed below, you’ll be able to significantly improve your claim payment success rate, enhance your understanding of urology coding, and elevate your coding accuracy. Here are Maldonado’s strategies for success.

Mistake 1: Discerning the Incorrect Code

During her HEALTHCON 2023 presentation, “Coding and Bundling Challenges in Urology,” Maldonado discussed how navigating the complex world of medical coding often leads to a divergence of opinions and interpretations. “I always say there is a difference of opinion [when coding], because we can actually present one operative report to five coders and everybody will come out with different codes,” said Maldonado. This variability is largely dependent on individual understanding of anatomy and the quality of communication with providers. The art of medical coding is riddled with differences of opinions between coders and payers, making it a challenging yet intriguing field.

“It all depends on your understanding — your understanding of anatomy and how well you communicate with your providers,” said Maldonado. Because of the complexity and variations in coding guidance and the differences of interpretations by payers, you will often run into differences of opinions between coders and payers.

For example: A common scenario you can encounter as a urology coder involves codes 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)).

Codes 52005 and 52332 are most often used when a provider is being called in to the hospital to prevent injury during surgical procedures. The urologist will put in the catheters, and at the end of the procedure, they will remove them. The correct code for this would be 52005, not 52332, but the provider needs to use clear language to communicate that to the coder to ensure that the claim is paid. “We are trying to educate the providers that their documentation is key and will help the coder choose the right code,” said Maldonado.

This situation was causing confusion for the coder because the provider continued to put in the operative report that they placed stents, which is referenced in the descriptor for 52332, instead of saying they placed catheters. “Because of this language, the coder was not understanding that they should be using 52005, not 52332,” said Maldonado.

Mistake 2: Extracting Tumor Size from the Pathology Report

Bladder biopsy codes can be tricky to navigate. In one example, Maldonado warned against using the pathology report to record the size of bladder tumors such as you normally would with the codes below:

• 52224 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy)
• 52234 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm))
• 52235 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm))
• 52240 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s))

Maldonado emphasized that you should take all lesion measurements from the provider’s notes in the operative report and not the report from pathology. “I continue educating the providers as we read their procedure notes,” Maldonado said. When a provider is performing a resection or fulguration of a bladder tumor, for example, the provider is the only one who can provide the approximate size of that lesion, and it should be documented in the operative report. “Do not use the pathology report, because once the tissue goes in the fixative, it shrinks and that is not the correct size. If there isn’t an exact size in the procedure notes, it will be downgraded to code 52224,” said Maldonado.

Remember: When there are multiple tumors, you will always want to code by the largest lesion, as you are not allowed to add multiple lesions together. You must also make sure the correct size is documented in the operative report.