Urology Coding Alert
Use CCI Edits to Demystify Bundles
Question: I can't figure out whether certain procedures are bundled, let alone how to code for them: bilateral retrograde pyelography, right uretero-nephroscopy, right stent insertion, and dilation of right ureteral orifice. Do you have any advice for me? Texas Subscriber Answer: The key to coding these procedures correctly can be found in the Correct Coding Initiative edits. Always remember that you cannot report 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) with codes 52341-52346 and 52352-52355 and no unbundling is allowed. In addition, several important codes are bundled into 52351, according to the CCI edits:
Proper billing for your prescribed scenario may include a maximum of five codes: 52351-RT for the right ureteronephroscopy including the ureteral dilation, 52332-59-51-RT for the right stent insertion, 52005-59-LT for the left cysto and retrograde pyelogram (if the study is performed for a separate and significant problem with a different diagnosis for the left urinary tract), 74420-26 if the urologist reads the retrograde films and writes a report, and 76000-26 if fluoroscopy is used. Modifier -59 is Distinct procedural service, -51 is Multiple procedures, and -26 is Professional component. Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.
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