Urology Coding Alert

Question: The physician did a direct vision internal urethrotomy and then did a biopsy of the urethra. Can I report these two codes (52276 and 52204) together with a 59 modifier? I know I can use the modifier, but should I?

Virginia Subscriber

Answer: The Correct Coding Initiative (CCI) does bundle 52204 (Cystourethroscopy, with biopsy[s]) into 52276 (Cystourethroscopy with direct vision internal urethrotomy).

But as you mention, you can break the bundle with a modifier under the proper clinical circumstances.

In the scenario you describe, you have three coding options based on the clinical scenario your urologist explains in his operative report.

Option 1: If your urologist did a biopsy of another area of the urinary tract, such as the bladder or prostatic urethra, report both 52276 for the visual urethrostomy and 52204 for the biopsy. Append modifier 59 (Distinct procedural service) to 52204 to break the bundle.

Option 2: If the urologist did the urethrostomy and a biopsy of the strictured area treated, you would only bill for the urethrostomy (52276).

Option 3: If the urologist first did the biopsy and waited for a frozen section, the result of which led him to do the urethrostomy at the same encounter, you would then report both codes (52276 and 52204-59).