Urology Coding Alert

Question: I just read about a case where a urologist placed a stent after dilating the ureter and UPJ with 12 French dilators. It also states a retrograde pyelogram was shot under fluoroscopy. The article stated to code this using just 52332. It states the dilation would be 52281, which is of course bundled with 52332. Shouldn't you report it as 52341 because it was a ureteral dilation?


Maine Subscriber

Answer: Often coders use and post the medical terms "urethral stricture" and "ureteral stricture" incorrectly because of an improper perception of these words by the transcriptionist typing an operative report. This appears to have been the problem in your case report. Likely, only a ureteral stricture at the ureteropelvic junction (UPJ) was present, and the urologist treated this stricture, not a urethral stricture.

The proper coding you should therefore use for this surgical scenario would be: 52342 (Cystourethroscopy; with treatment of ureteropelvic junction stricture [e.g., balloon dilation, laser, electrocautery, and incision]) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the same operative session.

Remember: If there was no stricture in the ureter or at the UPJ, and the urologist only did the dilation to facilitate passage of the stent, code only for the stent placement (52332), not also for the dilation.

Note: The Correct Coding Initiative (CCI) bundles the cystoscopy and retrograde pyelography as well as fluoroscopy into 52342 and 52332, so you cannot bill separately for them.

Alternative: If in fact there was a urethral stricture and the urologist also dilated (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), you would not be able to bill for it. CCI bundles this treatment into 52332 and also into 52342, and you cannot unbundle these edits using a modifier at any time.