Urology Coding Alert

Question: Is CPT 52005 a bilateral procedure? The physician does the same procedure for each ureter.

Oregon Subscriber

Answer: Some commercial payers may pay for 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) when it's reported bilaterally with modifier -50 (Bilateral procedure). But Medicare will not. According to the Medicare Carriers Manual (MCM), the basic procedure "is an examination of the bladder and urethra (Cystourethroscopy), which are not paired organs." The code acknowledges that the urologist may need to catheterize and examine one or both ureters.
 
"No additional payment is made when the procedure is billed with bilateral modifier -50," the MCM states. "Neither is any payment made when both ureters are examined and 52005 is billed with multiple-surgery modifier -51." Don't bill code 52005 twice, once by itself and once with modifier -51, if both ureters are examined.
 
In fact, Medicare has priced 52005 on the basis that it may be performed bilaterally. Medicare and private payers will pay the same fee for either unilateral or bilateral 52005. A few payers, particularly unions, recognize bilateral catheters and will pay an extra charge. Check with the payer, asking how it wants the procedure coded: one line with modifier -50 (52005-50) or two lines (52005 on the first line, and 52005-50 on the second; or 52005-LT on the first line, and 52005-RT-50 on the second line).
 
Tip: Code 52005 is site-dependent priced. Performed in the office, payment will increase by 70 percent to 75 percent. Remember also to charge for reading the pyelogram (74420, Urography, retrograde, with or without KUB, in the office, or 74420-26 [Professional component] in the hospital).