Urology Coding Alert

Question: What is the correct way to bill for a UroLume stent?

Connecticut Subscriber
 
Answer: UroLume is a brand name for a stent approved for the treatment of urethral stenosis or strictures. The correct code for the placement of the UroLume stent is 52282 (cystourethroscopy, with insertion of urethral stent).
 
Do not bill for the stent itself; this is an inpatient or outpatient procedure and the hospital will bill for the supply. According to CMS, 52282 is not an approved procedure for an ambulatory surgical center. 
 
The urologist may have to remove the stent, and perhaps replace it as well. Check with your carrier for frequency limits for this code. HGSA of Pennsylvania, for example, says that one to three stents may be needed: The procedure may be performed more than once, as a second UroLume prosthesis may be necessary or the prosthesis may have to be removed. Your carrier may designate reasons for removal. HGSA specifies migration of the stent, UTI, patient unable to tolerate stent and stent not effective.
 
When you must remove the UroLume stent, code 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) or 52315 (... complicated).
 
HGSA allows the insertion of the UroLume stent for the following diagnoses: detrusor sphincter dyssynergia (596.55), urethral stricture due to unspecified infection (598.00), urethral stricture due to infective diseases classified elsewhere (598.01), traumatic urethral stricture (598.1), postoperative urethral stricture (598.2), other specified causes of urethral stricture (598.8), unspecified urethral stricture (598.9), benign hypertrophy of prostate (600.0), nodular prostate (600.1), benign localized hyperplasia of prostate (600.2) and unspecified hyperplasia of prostate (600.9).
 
Always check your own carrier for specific acceptable diagnoses. Not all carriers will pay for a stent for BPH. When removing the stent, use diagnosis code 939.0, 996.65 or 996.76.  
 
-- Answers to You Be the Coder and Reader Questions provided by Michael A. Ferragamo, MD, assistant clinical professor at the State University of New York, Stony Brook; Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver; and Morgan Hause, CCS, CCS-P, coding compliance specialist for Urology of Indiana in Indianapolis.