Urology Coding Alert

Question: If patient has a urethral stricture, and the physician performs sound dilation "prior to" the cystoscope being inserted, is it appropriate to code 52281, or is this code only appropriate for "through the scope" dilation?

Tennessee Subscriber

Answer: NCCI bundles 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female) into most if not all other transurethral procedures, with no modifier allowed to bypass the edit.

Translation: If your physician does dilation and cystoscopy during the same session for a pre-existing urethra stricture, then submit 52281. This is true even if the dilation was not done through the scope.

CPT® code 53600 (Dilation of urethral stricture by passage of sound or urethral dilator, male; initial) is only reported in those cases where the doctor does a dilation but does not do a cystoscopic examination during the same session. Remember if the physician performs a urethral dilation to facilitate the insertion of the cystoscope when the urethra is normal but narrow and no stricture is present, then only bill for the cystoscopic examination with 52000 (Cystoscopy [separate procedure]).