Reader Questions:
52281 and 52204? Depends on the Payer
Published on Mon Jan 17, 2011
Question: One year following a radical prostatectomy for prostatic carcinoma, the patient underwent a cystourethroscopy, bladder neck dilation, and bladder and vesicourethral anastomosis biopsies. The diagnoses were hematuria of uncertain etiology, history of prostate cancer, and urethral stricture. How would I code this case?Answer: You will run into bundling issues when coding for this case. Nevertheless, you should report the following codes: 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) for the dilation of the bladder/vesical neck52204 (Cystourethroscopy, with biopsy[s]) for the multiple biopsiesAttach modifier 59 (Distinct procedural service) to 52204 to break the bundle between 52281 and 52204.Stumbling block: Medicare payers will not pay you for 52204-59 because the Correct Coding Initiative (CCI) bundles 52281 and 52204 and you cannot bypass the edit with any modifier. However, some private payers may pay [...]
