Urology Coding Alert

Question: The coding edit between 52351 and 52204 lists 52351 as the comprehensive code, but it seems to me that more work is done by the biopsy. Can you explain the logic behind this to me?

Nevada Subscriber

Answer: The work described by code 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) suggests that the provider performed a diagnostic cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings. He also passes a ureteroscope through the urethra and into the bladder, and performs a ureteroscopy (inspection of the ureter) and/or a pyeloscopy (inspection of the renal pelvis).

As you can see, the descriptor for 52351 does not specify that a bladder biopsy was performed. That is covered by code 52204 (Cystourethroscopy, with biopsy(s)).

As you stated, coding edits bundle codes 52351 and 52204. However, you sometimes can bill the procedures together if the circumstances are warranted and if you have sufficient documentation. When you do, append modifier 59 (Distinct procedural service) to code 52204 for private insurers or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) for Medicare and be sure to include all supporting documentation.