Urology Coding Alert

Question: The doctor performed a cystoscopy in the office to remove a stone from prostatic urethra but failed. He scheduled the patient for the OR that same evening and performed another cystoscopy and extensive transurethral excision of calcified prostatic urethral polyps. I used 52000 for the original office cystoscopy, then 52355-22 for the OR cystoscopy. We want to know if a modifier really should be applied to the OR cysto and which modifier to use. Louisiana Subscriber Answer: You will definitely need a modifier to code this procedure correctly, but it is needed on the initial cystoscopy, 52000 (Cystourethroscopy [separate procedure]), and it is modifier -59 (Distinct procedural service) that is required. Although 52000 is a "separate" procedure, it is bundled into the later TUR procedure. However, since the cystoscopy was performed at a separate encounter during the same day, one is entitled to payment - modifier -59 ensures payment for the cystoscopy. The second procedure should be coded as either a transurethral resection of the prostate (TURP) or a partial TURP (52612) depending on whether the prostatic tissue was also resected when removing the polyps and especially if the pathology revealed the polyps to be hyperplastic prostatic tissue, ICD-9 code 600.2.

In contrast, if the polyps were transitional cell type tumors, you should consider using one of the codes for TUR, transurethral resection of the bladder - 52224-52240 - depending on the size of the polyps. One coding scenario would be 52235 and 52000-59 with the ICD-9 diagnosis 189.3 (Malignant neoplasm, urethra).