Urology Coding Alert

In CCI version 7.1 the new 2001 codes for ureteroscopic procedures (52341-52355) have no bundled component codes. Under this version of CCI, a urologist could bill for multiple ureteroscopic procedures at the same encounter following endoscopic family code rules without the need for modifiers -51 (multiple procedures) or -59 (distinct procedural service).

For example, a urologist performs a ureteroscopic lithotripsy for a ureteral stone and then removes the fragments under ureteroscopically viewed basket extraction. Technically, under CCI as it now stands, the physician can code both procedures, 52353 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) and 52352 (... with removal or manipulation of calculus [ureteral catheterization is included]), receiving full payment for the lithotripsy and also payment for the stone extraction minus the endoscopic base code (52351) charge.

In addition, insertion of a self-retaining J stent (52332) is no longer bundled into the above ureteroscopic procedures and becomes a payable charge without modifier -59. However, you need to consider proper coding, not just the CCI edits. If you file two codes inappropriately, the payer could charge you with fraud, whether the codes are bundled in CCI or not.

Bill According to CCI Intent

The ureteroscopy code numbers were new as a result of renumbering for CPT 2001. When new codes come out, we dont get them in CCI immediately theres a process, says Mary Adam, president of Reliance Safeguard Solutions, the CCI contractor since last September. But providers bear the responsibility for correctly coding their claims, regardless of the presence or absence of CCI edits.

You dont have to guess what CCI officials intend. You have to follow surgical coding principles, regardless of what CCI says. For example, do not code a ureteroscopic ureteral tumor biopsy (52354) with a ureteroscopic ureteral tumor resection (52355).

In other words, bill according to the intent of CCI. Yes, you may be able to bill and be paid for ureteroscopy procedures that were formerly bundled. But you may also have to pay that money back, perhaps with penalties.

You may be able to bill double-J placement (52332) with ureteroscopy codes, however, since CPT endorses separate billing with modifier -59. Watch future versions of CCI for these new codes to be added.