Urology Coding Alert

Question: I need help with the proper billing for cystoscopy/ureteroscopy. For example, a patient undergoes a cystoscopic examination, a retrograde pylogram, and a flexible ureteroscopy to examine a possible UPJ obstruction. The physician placed a right stent, which I know is coded with 52332. I want to make sure I understand the proper/correct coding for the ureteroscopy. Some of the CPT^® codes have the description listed as “Cystourethroscopy, with ureteroscopy” but other descriptors just state “Cystourethroscopy.” Our physicians do many procedures using both a cystoscope and ureteroscope. Should I be using code 52351 in addition to the other procedures when reporting the ureteroscopy?

Arizona Subscriber

Answer: Yes, you can code for ureteroscopy in addition to other procedures. If the physician has performed cystourethroscopy, ureteroscopy, pyeloscopy, ureteral stent placement, and retrograde pyelogram, you may report individual codes for all these procedures as follows:

• 52351 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic
• 52332 – Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
• 74420-26 – Urography, retrograde, with or without KUB; Professional component.

The cystourethroscopy and retrograde pyelogram are included in both CPT^® codes 52351 and 52332 and should not be billed separately.

With the exception of the above, there are no CCI edits among these codes. Therefore, you may report all on the same claim (with clear documentation of each service). Always remember to check the CCI edits before reporting multiple codes, and remember only bill 74420-26 if an interpretation of the retrograde study was made by the urologist in hospital (need for modifier-26) and documented on a separate page in the medical records. You did not include this documentation in your question.