Urology Coding Alert

Question: We performed a radical cystectomy with an ileal conduit diversion (51595) for a patient with bladder cancer. Six months later, she was diagnosed with urethral carcinoma and had a "total urethrectomy." How should I code this?

Arizona Subscriber

Answer: Because the patient is female, you should report 53210 (Urethrectomy, total, including cystostomy; female). For a male patient who undergoes the same procedure, you would report 53215 (... male).

Because the procedure includes a suprapubic cystostomy in a patient whose bladder has been removed, you must add modifier -52 (Reduced services) to whichever code you use. Send a paper claim and include an operative report. Be sure to include a note explaining the procedure exactly. Note that the urethrectomy is the major part of 53210 or 53215, and would constitute 80 percent of the full procedure. The payer will likely pay 75 percent of the full fee.