Urology Coding Alert

Reader Question:

Append -52 for Failed Dilation

Question: A physician did a consult in the hospital and attempted to insert 16 french coude, 5 french spiral filiform and also attempted flexible cystoscopy and was unsuccessful, "unable to see in bladder." How should I code this? North Carolina Subscriber Answer: You will need two modifiers, -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and -52 (Reduced services). To code the hospital consultation, choose the most appropriate code from the facility consultation codes 99251-99255 depending on the levels of history, examination and medical decision-making documented by the physician and append modifier -25. For the attempted but unsuccessful dilation, you should report 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female) and append modifier -52 as an indication to the payer that the full service was not rendered. Be sure the attempts are documented in the operative report.  
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Urology Coding Alert

View All