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Urology Coding Alert

Reader Question:

Bundling 52310 and 52351

Published on Wed Aug 01, 2001

Question: One of our insurance companies includes CPT 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) in the fee for 52351 (cystourethro-scopy, with ureteroscopy and/or pyeloscopy; diagnostic). Is this correct?

New York Subscriber  
Answer: The most recent Correct Coding Initiative edits, version 7.2, do not bundle 52310 as a component code of 52351, so both can be billed at the same time. The separate-procedures indicator on 52310 may be the issue, or the payers editing software (e.g., ClaimCheck) bundles the procedures. The denial should be appealed with documentation, addition of an appropriate modifier, such as modifier -59 (distinct procedural service), and a letter explaining the circumstances. But the appeal may fail. Ultimately, the payer has the authority to dictate how claims for its beneficiaries will be processed and paid.
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