Urology Coding Alert

Question: We have had trouble coding for a certain procedure at our office. The physician describes the procedure as "cystourethroscopy direct vision internal urethrotomy with random bladder biopsies." Biopsies were done at the dome, left and right wall, and floor. The diagnosis was microhematuria with urethral stricture. Are there codes for this?

Georgia Subscriber

Answer: Two issues could be complicating your billing: Correct Coding Initiative bundles, and unspecific diagnosis codes.

First, 52204 (Cystourethroscopy, with biopsy) is bundled in with 52276 (Cystourethroscopy with direct vision internal urethrotomy), according to the CCI guidelines. To be properly reimbursed for both procedures, you need to append modifier -59 (Distinct procedural service) to the biopsy codes to illustrate that the biopsy took place in the bladder, not the urethra. You should bill the following: 52276 for the visual internal urethrotomy; and 55204-59, 55204-59, 55204-59 and 55204-59 for the four bladder biopsies.

Make sure you send the bladder biopsies separately to pathology to solidify that they were separate procedures and were obtained from different areas of the bladder.

The second problem may be the diagnosis code, 598.9 (Urethral stricture, unspecified), which you may be using for the urethral stricture. Code specifically to the stricture etiology using diagnostic codes 598.00, 598.01, 598.1 or 598.2 instead.

The physician needs to be extremely specific about the reason for performing the biopsies of the bladder. Are they carcinoma in situ (233.7)? Or does the mucosa look normal but the patient has hematuria? It is common when doing biopsies of normal-looking bladder mucosa to use diagnostic code V71.1 (Observation for suspected malignant neoplasm). The hematuria (599.7) would be used as a secondary diagnosis.