Urology Coding Alert

Question: A patient come into the office for a cystoscopy and bladder ultrasound. Due to his findings, the urologist sent the patient directly to the hospital and completed a transurethral resection of an anastomotic bladder neck stricture and removal of bladder stones later that same day. Is it possible to get paid for both procedures?


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Answer: For the ultrasound of the bladder in the office, report 76857 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]), and for the cystoscopy use 52000 (Cystourethroscopy [separate procedure]).
 
Use 52640 (Transurethral resection; of postoperative bladder neck contracture) for the transurethral resection of an anastomotic stricture the urologist performed in the hospital.

You should also report 52315 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; complicated) for the removal of bladder calculi.
 
Use 52315 rather than 52310 (… simple) because the physician removed more than one stone.

The National Correct Coding Initiative, version 11.3, bundles 52000 into 52640 and 52315. You’re not allowed to break either bundle with a modifier. Coding experts believe, however, that you should be paid for  the cystoscopic procedure performed in the office in   the morning.

The cystoscopic examination was diagnostic, and as such it was the precipitating factor for the patient’s admission to the hospital and subsequent surgery.

Experts suggest appending modifier 59 (Distinct procedural service) to 52000 and sending documentation of what was done and why. If the claim is still denied, you should appeal. You should send complete detailed documentation of the encounter in the office in the morning and later that day in the hospital.

Also, include a cover letter indicating to the carrier what procedures your urologist performed at each location.

Note: If the anastomotic stricture followed a radical prostatectomy, and your urologist created an incision through the anastomotic strictured bladder neck, use code 52276 (Cystourethroscopy with direct vision internal urethrotomy) for the opening of the stricture at the urethrovesical anastomosis instead of the codes listed above.