Urology Coding Alert

Question: Can a physician report the following CPT^® codes: 52352, 52353, 52356, and 52648 when billing a place of service 11?

AAPC Forum Participant

Answer: You are able to bill 52648 (Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)) in a facility, hospital, or ambulatory surgical center (ASC), as well as in a place of service (POS) 11(Office setting).

On the other hand, a physician can only bill for 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)), 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)), or 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) when performed in a facility such as a hospital or ASC, but not in an office setting. “These procedures are not performed in the office setting due to the fact that there is no assigned reimbursement for the procedure in the office setting,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland. There is no practice expense for clinical labor, equipment, and supplies to perform the procedure in the office. There are other considerations such as anesthesia requirements as well.