Urology Coding Alert

Question: Can urology procedures be billed bilaterally? In particular, I am confused about billing for CPT 52351. Where can I find this information?

Kansas Subscriber

Answer: The answer to your question is in the Medicare Physician Fee Schedule Database but don't be surprised if non-Medicare payers don't adopt these same policies. Though most carriers do use it to some degree, you should be able to obtain this information from your carrier or its Web site.

To bill for bilateral procedures, you need to use modifier -50 (Bilateral procedure). Although you can bill bilaterally for most urology procedures, code 52351 is an exception to the rule. You can always try to use 52351 (Cystourethro-scopy, with ureteroscopy and/or pyeloscopy; diagnostic) with modifier -50 appended and appeal any denial, whether it is from Medicare or another carrier.

An alternative is to use modifier -59 (Distinct procedural service) and bill one line 52351 and a second line 52351-59 indicating that the same procedure was performed on different kidneys.

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.