Urology Coding Alert

Question: I have an operative report that states: "Cystoscopy, fulguration of a 1-cm bladder tumor. Open excision of distal ureter tumor. Fishmouth reimplantation of right ureter." How I should code this?


South Carolina Subscriber

Answer: First, report 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) for the reimplantation of the right ureter into the bladder.

Then, for non-Medicare carriers, you should report 50650 (Ureterectomy, with bladder cuff [separate procedure]) for the excision of the lower ureter and bladder cuff. Append modifier 51 (Multiple procedures) to indicate your urologist performed more than one procedure during the same operative session.

Next, report 52234-51 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) for the fulguration of the 1-cm bladder tumor.

Important: The Correct Coding Initiative (CCI) bundles 50650 into 50780, and you cannot override the bundle using a modifier. Therefore, you won't see separate payment for the second code from Medicare and any carrier following CCI rules. But you should bill non-Medicare carriers because a few will not follow CCI and will reimburse something for this secondary procedure.