Urology Coding Alert

We wish to clarify the information in the February article, News Brief: Controversy Surrounds CCI Changes to 52001, on page 12 of the Urology Coding Alert: urologists should not use new code 52001 (Cystourethroscopy with irrigation and evacuation of clots) for evacuation of a few small clots. The new code is to be used primarily when clot evacuation precedes cystoscopic examination because evacuation is needed to relieve retention and improve visualization of the bladder. This code will be most often used in the hospital environment, says Michael A. Ferragamo Jr., MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook.
 
When only a few small clots are evacuated and a cystoscopy is performed, use 52000 (Cystourethroscopy [separate procedure]) instead.
Vignette Used in Code Application  
In the vignette used by the AMA in considering the development of this code, there is clearly more than a single clot. The example involves a 65-year-old male who goes to the emergency room with pain and bloody urine with clots. The urologist finds that the bladder is distended and places a catheter, but it quickly becomes obstructed due to clots. Several more catheters are placed, with the same problem of obstruction. The patient is then taken to the operating room, where a cystoscopy reveals prostatic bleeding with massive clots in the bladder. The clots are evacuated, and subsequent inspection reveals no clots. A Foley catheter is then placed and, when the liquid is clear, the patient is taken to the recovery room.
 
Code 52001 pays more than 52000 when performed in the hospital. When done in the office, 52001 pays less than 52000. The correct code for clot evacuation with cystoscopy is 52001; do not use 52000 with 51700* (Bladder irrigation, simple, lavage and/or instillation) instead.
More Work for 52001 than 52000  
Clot evacuation performed in the office requires more work than when cystoscopy alone is done, so something is wrong with the fee schedule. In the office, a small flexible cystoscope is inserted; if clots are seen, the small cystoscope is withdrawn and a large catheter is inserted. Irrigation is performed with clot evacuation, and then cystoscopy is performed. This is clearly more work than simple cystoscopy.
 Irrigation of large clots is usually done in the hospital anyway, Ferragamo says, because the cystoscopic sheath is large enough to warrant performing the procedure under anesthesia. The patient would certainly need anesthesia with the Ellik evacuator, Ferragamo says. In the office, I would use a piston syringe, if necessary.
 
If a patient has only a [...]