Urology Coding Alert

Question: I am confused about the rules for billing CPT 52000 and CPT 51010 with a sling operation for stress incontinence. How should I bill these as not to get my claims denied?

Mississippi Subscriber

Answer: Let's start with how to bill 52000 (Cystourethroscopy [separate procedure]) with 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]). According to AUA and American Ob-Gyn Association guidelines, you should not have a problem billing these two procedures if the cystoscopy is performed for diagnostic reasons such as evaluation for a history of bladder tumors or hematuria, and remember to append modifier -51 (Multiple procedures) to receive reimbursement. You cannot code 52000 with 57288 if the cystoscopic examination is only performed to ensure that a suture did not damage the bladder during the sling procedure.

As for billing 51010 (Aspiration of bladder; with insertion of suprapubic catheter) with a sling operation, there is no current CCI edit that prohibits - with a bundle - separate billing of these procedures. If you do not deem the cystostomy an integral part of the procedure and you have thorough documentation, you should not have any problems getting paid for the latter code 57288 and 51010-51 for both procedures.

However, many carriers may have their own opinions on whether 51010 is an integral component of 57288 and may therefore deny payment. With your appeal, you should send the carrier a copy of the CCI edit page that illustrates there is no bundling of 51010 into 57288 and attach an explanation of why 51010 is not an integral part of the sling procedure.