Urology Coding Alert

CPT Assistant clarified several coding questions for urologists this fall including modifier use for stents during diagnostic cystoscopies, stone removal and contralateral procedures.
Stent Placement
Code stent placement (52332, cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) immediately following diagnostic cystourethroscopies (52320) with modifier -51 (multiple procedures), CPT Assistant of September 2001 states. If stents must be inserted in both ureters, append modifier -50 (bilateral procedure) to 52332.
 
CPT Assistant like CPT is independent of CMS rules and the Correct Coding Initiative (CCI). According to the most recent version of CCI, 52332 is bundled into both cystoscopic stone manipulative procedures: 52320 (cystourethroscopy [including ureteral catheterization]; with removal of ureteral calculus) and 52330 ( with manipulation, without removal of ureteral calculus). With those codes, 52332 will need modifier -59 (distinct procedural service) as well as -51.
Stone Removal
CPT Assistant, September 2001, also discusses the use of modifier -22 (unusual procedural services) for stone removal. If significant extra work is done, append modifier -22. For example, a urologist removes three ureteral calculi. Use 52320 and append modifier -22. Document the extra time and work involved in removing three stones.
Contralateral Procedures
In the October issue, CPT Assistant discusses proper modifier use when a procedure is performed on one side and another is performed on the other side. For example, a urologist performs 52341 (cystourethroscopy; with treatment of ureteral stricture [e.g., balloon dilation, laser, electrocautery, and incision]) on the left side. During preparation for the procedure, the patient complains of right flank pain. The urologist performs a diagnostic ureteroscopy (52351, cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) on the right side during the same session. To report both codes, append modifier -59  to 52351.
 
If, in performing a cystourethroscopy, a urologist finds a stricture and eliminates it by balloon dilation, laser electrocautery or incision, only 52341 can be reported, CPT Assistant says. Both the cystourethroscopy and the stricture treatment were done on the same side. If the J stent is placed, use 52332-51 also.
 
The following codes can be used with modifier -50, CPT states: 50020-50290; 50390-50405; 50541-50548; 50551-50580; 50590; 50605-50630; 50740-50760; 50780- 50840; 50860-50940; 50945-50980; 52005-52010; 52320-52355; 54500-54680; 54690- 54692; 54700-54840; 55400; 55500-55550.
 
"According to CPT Assistant, you can unbundle these codes if contralateral procedures are performed," says Cynthia Jackson, RRA, CPC, a urology coding specialist in Lawrenceville, Ga. "For example, if you perform the comprehensive procedure on the left side, and the component procedure on the right side, you can bill for the component procedure by adding modifier -59 to the [...]