Urology Coding Alert

Long-awaited answers to coders' questions about whether indwelling J-stents can be separately coded using modifier -59 (Distinct procedural service) have finally surfaced it turns out -59 isn't your only option. Codes CPT 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) are bundled into the ureteroscopic codes, 52351-52355. Thus, urology practices are not receiving sufficient reimbursement for the insertion of indwelling stents, 52332, when performed in conjunction with the ureteroscopy. That's because procedure code CPT 52332 is considered a component of ureteroscopies' global surgical packages. Also, due to the bundling of the retrograde pyelogram, 52005, into the uretero-scopic code 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]), coders are not being reimbursed for the bilateral retrograde pyelogram procedure. Here's a scenario in which the above factors would reduce reimbursement: A patient presents with a possible left ureteral stone and a potential right renal pelvic stone. A bilateral retrograde pyelogram confirms both stones. The physician performs a ureteroscopic extraction of the left ureteral stone without difficulty and places double J-stents bilaterally.

How can coders combat claim denials for such a case? Here's what the experts suggest. Get Reimbursed for 52332 and 52005 The most obvious solution is to append modifier -59 to 52332 and 52005 to indicate that payers should consider the procedures separate. But this solution often results in claim denials, even though the AMA and the AUA endorse it. Although the CCI edits have bundled 52332 into the ureteroscopy codes and many other genitourinary procedures, the AMA and AUA maintain that these self-retaining, indwelling J-stents are separately billable with the correct use of a modifier. And surprise even CMS isn't to blame when payers deny unbundled claims. CMS "believes that the insertion of a permanent, self-retaining, indwelling stent is separately payable as CPT code 52332," says Linda S. Dietz, RHIA, CCS, CCS-P, coding specialist for the National Correct Coding Initiative. "The modifier of '1' allows modifiers associated with the NCCI, including the -59 modifier, as appropriate, to be used with the edits which bundle 52332 into 52351-52354."

Dietz cautions coders, however, to consider the global surgery modifiers -58, -78 and -79 before assuming -59 is the only suitable modifier. In fact, in the scenario presented above, modifier -50 (Bilateral procedure) is also an applicable modifier to 52332 because the stents were placed on both the right and left ureters; thus you would code the procedure 52332-50-59. Before you append -59, be sure you have met at least one of the criteria for this modifier. According to CCI [...]