Urology Coding Alert

Question: My urologist wants to file a claim with 51045 and 51865. Can we include both procedures, or is there a coding edit against that?

Missouri Subscriber

Answer: The Correct Coding Initiative (CCI) does not currently list any edits or “bundles” of 51865 (Cystorrhaphy, suture of bladder wound, injury or rupture; complicated) with 51045 (Cystotomy, with insertion of ureteral catheter or stent [separate procedure]). However, you will still want to verify that your surgeon has enough clear documentation to support reporting both codes.

If placement of the ureteral catheter or stent via a cystotomy (51065, Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus) is to help identify and avoid ureteral injury during complex bladder closure, then this would be considered part of the bladder closure and should not be billed separately. If placement of the catheters is purely “diagnostic” to rule out associated injury to the ureters, then one may also code and bill for their placement within the ureters. You will also want to check CPT^® guidelines to be sure you need both codes to accurately reflect the urologist’s work.