Urology Coding Alert

Question: A patient complaining of hematuria presented to one of our doctors. After evaluating the patient, the doctor performed a cystoscopy (in office) through an ileal conduit. How should we code for this?

Florida Subscriber

Answer: Great question. You are having difficulty identifying the correct code because the procedure that was performed was technically not a cystoscopy because the scope was not used to examine the bladder. When scoping an ileal conduit, your urologist is actually performing a gastroenterological procedure known as an ileoscopy, 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

If this was a new patient who received a complete evaluation (history, physical exam, and decision) that immediately (same day) resulted in the in-office ileoscopy, you should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service performed to ensure payment for the service. Be sure there is clear documentation of the symptoms and events leading up to the performed procedure.

Keep in mind that there are a number of urology-related codes in the gastroenterology, integumentary and neurology sections of CPT 2002.