Urology Coding Alert

Question: We billed Medicare for a cystoscopy with stent insertion using code CPT 52332 and were paid accordingly. But when we then billed Medicare 87 days later for a consult (99244-25) and a stent removal procedure (52310), we were not paid for the consult. Because the consults are required by our hospital, is there another code we can use that Medicare will accept?

Illinois Subscriber

Answer: Just because a hospital or other facility has a policy mandating consultations before stent removal procedures does not mean that these administrative requirements will be reimbursed only the CPT and Medicare guidelines dictate what is a reimbursable service.

However, if the consultation was a true, legitimate consultation requested by another physician, you deserve to be paid for both the consultation and the stent removal and can do so simply by appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consultation code. However, it appears that the consultation was only performed to fulfill the hospital's requirement, which means the only service you can bill is the stent removal, 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple).