Urology Coding Alert

Question: My urologist performed a ureteroscopy and biopsy of the renal pelvis and the proximal ureter. Can we charge separately for each biopsy? If not, can we report the code with modifier -22 (Unusual procedural services) to indicate to the carrier that the two biopsies were performed?

UCA Subscriber

Answer: It is unlikely that you will receive additional reimbursement for the urologist's having taken two biopsies that are represented in a single code, 52354 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion). However, depending on the urologist's documentation in the operative report, you may be able to append modifier -22 to the service.

It is rare for any carrier to reimburse for procedure 52354 twice, regardless of whether you bill with a 2 in the units column or report the procedure twice, appending modifier -59 (Distinct procedural service) to the second-line 52354.

But if the urologist spent at least 50 percent more time than usual to perform the procedure, the circumstances merit the use of modifier -22. But you can't just submit the claim with modifier -22 without any documentation to support it. To support the use of the modifier, the operative note must include documentation of the procedure in its entirety, indicating the source of the additional time spent.