Urology Coding Alert

Question: A patient underwent evacuation of multiple obstructing clots, which we reported with code 52001. Is there a code for cauterization to control bleeding from the bladder wall in this case secondary to radiation cystitis?

South Carolina Subscriber

Answer: You were correct to begin the claim with 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) for the evacuation of clots. Code 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) represents fulguration/cauterization of the bladder wall, but is part of a CCI edit (is bundled) with code 52001.

However, you are allowed to “break” this edit in appropriate circumstances by appending a modifier. Therefore, append modifier 59 (Distinct procedural service) or modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 52001 since it is the Column 2 code of the edit. The proper coding for this scenario in a hospital based on relative value units would be 52001 with either modifier 59 or XU and 52214.