Urology Coding Alert

Question: What is the difference between hydrodilation and irrigation or instillation? Are there different codes?

Kentucky Subscriber  
Answer: Hydrodilation is the process of distending the bladder with water. This helps the urologist visualize the bladder to better evaluate a condition like interstitial cystitis. There are two codes for hydrodilation: 52260 (cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) and 52265 (... local anesthesia). 
 
Instillation or irrigation (51700*, bladder irrigation, simple, lavage and/or instillation) is the placing of a therapeutic agent, such as medication, to treat interstitial cystitis. With instillation, the agent is left in the bladder. With irrigation, it is merely passed in and out. For example, if you instill, use 51700* and J1212 (injection, DMSO, dimethyl sulfoxide, 50%, 50 ml).
 
Although the chart notes may indicate that the bladder was dilated, coders should make sure the physician performed the dilation separately before coding 52260 or 52265. The agent that was instilled into the bladder or irrigated it might have been responsible for some dilation, but that is not the same as hydrodilation.
 
Occasionally a urologist will dilate the bladder just by putting fluids in, without cystourethroscopy. For this procedure, use 52265 with modifier -52 (reduced services) appended to indicate that you performed only the dilation part of the code.