Urology Coding Alert

Question: A patient was taken to the operating room and had a bilateral stent insertion because of an unrelated bilateral hydronephrosis along with a small TURBT and ureteroscopy and retrogrades. How should I report this procedure?

Pennsylvania Subscriber

Answer: You should first report 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) for the transurethral resection of the small bladder tumor (TURBT).Then, report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type]) for the stent insertion. Append modifier 59 (Distinct procedural service) to break the Correct Coding Initiative (CCI) bundle between 52234 and 52332. Also, attach modifier 50 (Bilateral procedure) since the stents were place bilaterally.

Here's why: Since the hydronephrosis was unrelated to the bladder tumor and the stent placements were not an integral part of the TURB, you can break the CCI bundle with modifier 59 and bill for both services.

Bill also 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) for the diagnostic ureteroscopy

Finally, report 74420 (Urography, retrograde, with or without KUB) for the retrograde pyelogram. Append modifier 26 (Professional component) since the urologist performed just the reading and interpretation, but the facility owns the equipment.