Urology Coding Alert

Question: My urologist performed a cytoscopy with biopsy of a small bladder tumor, a cystoscopy with fulguration, and bilateral retrograde ureteral catheterization all at the same patient encounter. Should I report all three of these procedures, 52204, 52214 and 52005, at the same time? Or is there one CPT code that represents all of these procedures performed at once?

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Answer: From the description you provided, it isn't easy to tell exactly what should be coded, but you can choose from the following possibilities depending on what best represents what your urologist has documented.

If your urologist fulgurated a small bladder tumor on one side of the bladder and then biopsied normal mucosa on the other side of the bladder, you should report both codes 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) and 52204-59 (Cystourethroscopy, with biopsy; Distinct procedural service) using modifier -59 to break the bundling of the two codes and sequencing the fulguration first because of its higher relative value unit. But if your urologist biopsied and then fulgurated the same lesion, you should only report code 52214.

As for the bilateral retrograde, this service is bundled into code 52214 when a screening diagnostic study is performed to explore for tumors in the upper tracts. However, if the bilateral retrograde is performed to confirm lesions previously identified in the upper tracts, you can unbundle the bilateral retrograde from 52214 with modifier -59, coding 52005-59 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; Distinct procedural service). Code 52005 is considered a bilateral code and does not require modifier -50 (Bilateral procedure) when reporting claims to Medicare. However, CPT guidelines condone the modifier -50 when reporting bilateral cystoscopies. Make sure you know whether your carrier adheres to Medicare or CPT guidelines before submitting the claim.

Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.