Urology Coding Alert

Question: When my urologist performs a cystoscopy through a stoma, should I use a regular cystoscopy code or an unlisted code?

Wyoming Subscriber

Answer: When the bladder is removed and replaced with a pouch, this leaves a stoma external to the skin. Therefore, when the urologist evaluates the pouch by cystoscopy, he or she does so through the stoma rather than the urethra. The question then becomes whether you should use the unlisted procedure code (53899) or the appropriate cyctoscopy code.

The unlisted code presents two problems: The payer determines the global period, and it gives the carrier too much control over your reimbursement for the procedure. A cystoscopy code isnt valid either, however, because there is no bladder or urethra.

If the patient has a normal bladder and an opening through the skin connected to the bladder via a piece of bowel, then use a cystoscopy code because there is a bladder. But in the case of the stoma to a pouch or conduit as a substitute urethra and bladder, you should use either 44380 (ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 44385 (endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Code 44380 is appropriate if you are looking in an ileum a segment of intestine that is used as a conduit. Code 44385 is correct if you are looking into an isolated segment of bowel acting as a continent pouch. Both procedures have a zero-day global period.