Urology Coding Alert

Urologists can be reimbursed for a bladder neck contracture treated by an incision method rather than a resection method, even though it lacks a specific code. Instead of using only the unlisted procedure code (53899), urologists have a choice of codes to bill.

The procedure involves cutting the contracted fibrotic neck transurethrally with a cold- or hot-knife incision. Use new code 52400 (this replaces 52340). A formal transurethral resection of the contracted bladder neck (52500) is less appropriate for a post-operative contracture (stricture), but is often used for a hypertrophied bladder neck associated with older males with obstructive symptoms and small prostates rectally.

The issue is whether the physician is doing it with a knife (52400) thats the incision or with a resectoscope (52500), says Mark Cendron, MD, associate professor of urology and pediatrics at Dartmouth Hitchcock Medical Center in Lebanon, N.H. Extra work is involved in using the resectoscope, he adds.

Simple Prostatectomy

Bladder neck contracture most often occurs after resection of the prostate, when the prostate has been removed, Cendron says. Some scar tissue builds up at the bladder neck where the prostate used to be, he explains. Either you take a resectoscope and cut it out with electrocautery, or you can do the same thing with a knife blade by incising the scar tissue. Many urologists choose the resectoscope, and for them, 52500 by itself is appropriate.

But urologists who make an incision instead of a resection after a simple prostatectomy should use either 52400 (cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds) or 52500 with modifier -52 (reduced services).

Code 52400 is for congenital anomalies. That might not seem proper for a condition that was induced by surgery, but in the absence of a more applicable code, it would be the best choice. The other option is to use 52500 with modifier -52 to indicate that only an incision, and not a resection, was performed.

Radical Prostatectomy

In treating an anastomotic (urethra to bladder neck) stricture after a radical prostatectomy, often described incorrectly as a bladder neck contracture, there are other options as well, Cendron says. These include 52275 (cystourethroscopy, with internal urethrotomy; male), 52276 (cystourethroscopy with direct vision internal urethrotomy) or 52277 (cystourethroscopy, with resection of external sphincter [sphincterotomy]). CPT Code 52277 is probably the most appropriate in terms of what is being done, except for the resection, Cendron says. When youre incising the bladder neck, youre incising a sphincter.

Many urologists incorrectly use 52450 (transurethral incision of prostate) for the procedure. The incision part is right, but the prostate part is not, and in a procedure following a radical prostatectomy, this code would clearly be wrong.

When there is no other code available, CPT instructs the coder to use the unlisted procedure code, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and reimbursement consulting company in Denver. In this case, 53899 would be appropriate, Page says. Personally, I like 52500-52 or 53899, she says. But if push came to shove, I think any of these suggestions 52500-52, 52400, 52275, 52277 or 53899 could be argued for successfully if the physician were challenged.