Urology Coding Alert

Question: How should I code the following procedure documented by the urologist: "Cystoscopy, injection of seminal vesicale with methylene blue under transurethral ultrasound, using transurethral ultrasound guidance, and unroofing of verumontanum and transurethral resection of ejaculatory ducts. Diagnosis: Low volume azoospermia and oligospermia with dilated seminal vesicles bilaterally"?

Montana Subscriber

Answer: First, report 52402 (Cystourethroscopy with transurethral resection or incision of ejaculatory ducts) for the resection of the ejaculatory ducts. Next, you should code 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) for the ultrasonic guidance.

Beware: There are three possible codes for the injection of the seminal vesicles ��" 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) as recommended by the American Urological Association's "Coding Tips 2003", or possibly 10021 (Fine needle aspiration; without imaging guidance) or 10022 (... with image guidance). The Correct Coding Initiative (CCI), however, bundles CPT code 90772 into 52402 and also into 10021. Therefore, you should consider the following coding: 52402, 76942-26 (Professional component), and 10022-51 (Multiple procedures).

Don't forget: The diagnostic codes you'll report based on the physician's documentation are 606.0 (Azoospermia), 606.1 (Oligospermia), 606.8 (Infertility due to extratesticular causes) which includes "obstruction of efferent ducts" and 608.89 (Other specified disorders of male genital organs; other for obstruction of ejaculatory duct[s]).