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Urology Coding Alert

READER QUESTIONS:

Check CCI Edits if You Face Denials

Published on Tue Aug 14, 2007

Question: I billed CPT 52001 and 52224-51. Medicare paid for 52224 but denied 52001. How should I have reported these procedures?


South Dakota Subscriber


Answer: You are on the right path. For your scenario, you should first report 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) for the cystoscopy and irrigation of multiple obstructing clots. Report this first because this CPT code has the higher relative value.

Next, report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to show that the fulguration was a separate procedure.

Key: You'll need to add modifier 59 (Distinct procedural service) to 52001 to break the bundle the Correct Coding Initiative (CCI) creates. Even though 52001 has the higher RVU, you'll append modifier 59 to that code because it is bundled into 52214. You can report these separately and expect separate payment if your urologist documented distinctly separate procedures. Beware of carrier scrutiny on modifier 59 use, however.

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