Urology Coding Alert

Question: Can we bill CPT 52005 and CPT 52332 when they're done at the same session, if we append modifier -59 to 52005? Our coding consultant says we can't and insists that modifier -59 represents entirely different encounters. The doctor thinks we should be able to, because the decision to place the stent was based on the pyelogram's findings.

Indiana Subscriber

Answer: Your coding consultant is right. You can't report both codes for a single surgical session and expect reimbursement -- but not because this case doesn't merit modifier -59 (Distinct procedural service).

NCCI version 10.0, effective as of this past January, changed the status indicator for the 52005/52332 bundle from "1" to "0." The "1" indicator allowed for unbundling under certain circumstances, such as procedures performed on different ureters.

The new "0" indicator, however, means you now cannot report both procedures on the same patient by the same doctor on the same day in any circumstance, modified or not. Medicare considers 52005 (Cystourethro-scopy, with ureteral catheterization, with or without irrigation, installation or ureteropyelography, exclusive of radiologic service) to be an integral part of 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent) -- and many other cystos -- and thus never separately reportable. Code 52005 is also the base code for 52332, and as such is never payable when billed together with 52332.

Loophole: You may be able to bill non-Medicare patients for both. The January 2001 CPT Assistant advises that they can be billed together. Check commercial payers to see if they allow this under these guidelines from the American Medical Association.