Urology Coding Alert

Question: Our provider performed a cystoscopy, bladder biopsy with fulguration, and fistulogram in an ASC. Is the fistulogram separately billable from the bladder biopsy? If so, what procedure code would we report?

Mississippi Subscriber

Answer: You should report 20501 (Injection of sinus tract; diagnostic [sinogram]) since your urologist also performed the fistulogram. If your urologist documented that he also interpreted the fistulogram, include 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation) for that service. Append modifier 26 (Professional component) to represent the urologist only interpreting and reporting the results.

Refresher: A fistula is an abnormal passage, typically between two organs. The term sometimes is used to describe any abnormal passage, including a sinus tract. A fistulogram is an X-ray to view the extent of a fistula.