Urology Coding Alert

Question: My urologist did a cystoscopy with bilateral retrogrades, right ureteral brush biopsies and random bladder biopsies. I know some of these cannot be billed together, but I cannot decide how to bill this. His diagnoses are abnormal urine cytology and filling defect right ureter. How should I code this?

Answer: First, report 52007 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis) for the cystoscopy and brush biopsies. Then, code 52204 (Cystourethroscopy, with biopsy[s]) for the bladder biopsies. Append modifier 59 (Distinct procedural service) to 52204 to show that the bladder biopsies represented separate procedures. You may bill both the biopsies of the upper urinary tract and biopsies of the lower urinary tract as they represent separately performed surgical procedures during the same encounter.

Append ICD-9 diagnosis codes 793.5 (Nonspecific [abnormal] findings on radiological and other examination of body structure, genitourinary organs, filling defect, ureter) and 795.4 (Other nonspecific abnormal histological findings) for the abnormal urinary cytology.

Don't miss: If the urologist reads the pyelogram, report 74420 (Urography, retrograde, with or without KUB). Append modifier 26 (Professional component) to indicate your physician only performed the professional component, the interpretation of the x-ray films.

Cystoscopy and retrograde pyelogram are bundled into 52007, and you cannot bill or unbundle them. You cannot bill for the cystoscopy (52000, Cystourethroscopy [separate procedure]) or retrograde pyelogram (52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service) because both codes are included in the 52007 coding, per the Correct Coding Initiative (CCI).