Urology Coding Alert

Question: Which codes should I use for a cysto with retrograde followed by placemet of ureteral stent for ureteral stone at the same time? Also, if I use code 52281 with stone codes, which modifier should I use to get payment for both, and does it matter if the code that pays the most is sequenced first?

Arkansas Subscriber




 Answer: From your question it appears that the following was performed: a cystoscopic examination, a retrograde pyelogram, urethral dilation of a stricture, and a ureteral stent placement for a ureteral stone.

The urethral dilation is bundled into code 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) and cannot be unbundled. You should use 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), which is not bundled, in an attempt to be paid for the dilations. Remember also that the cystoscopy is included in 52332. So this clinical scenario would be coded 52332 and 74420-26 (Urography, retrograde, with or without KUB; Professional component).

Because this procedure is primarily performed in the facility setting, modifier -26 is required to indicate that the urologist only read and interpreted the retrograde pyelogram and did not own the radiological equipment. If, however, on rare occasions the procedure was performed in the office, you should report 74420 without a modifier. Be sure the urologist has an interpretation and report in his documentation before reporting this service.