Urology Coding Alert

Reader Questions:

52281 and 52204? Depends on the Payer

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 [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Urology Coding Alert

View All