Urology Coding Alert

According to the Correct Coding Initiative (CCI), 52005 (cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) and 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) are bundled procedures and not payable together. The rationale is that 52332 includes the catheterization. But many urologists bill for the 52005 also, using modifier -59 (distinct procedural service).

Medicare views the catheterization and pyelogram as an integral part of the stenting procedures, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stonybrook, and a urology coding trainer. Under these circumstances, Medicare bundles these procedures and will only reimburse for the stent placement (52332), he says. Usually, the urologist needs a clear picture of the ureter before putting in the stent by doing the pyelogram.

But, CPT does not recognize the CCI bundling. In the January 2001 issue, CPT Assistant says, It would be appropriate to report 52332 in addition to 52005 when an indwelling stent is placed in addition to a diagnostic cystourethroscopy.

CPT Assistant stops short of recommending modifier -59. Instead, it states the following: It is important to note that the code edit includes a superscript of 1, which according to the CCI guidelines indicates that a modifier is allowed in order to differentiate the services provided. Therefore, according to the CCI Edits, provided the services described by codes 52332 and 52005 are performed, both codes may be reported with a modifier, as appropriate. You should refer to the CCI Manual for the list of modifiers that can be reported.

Although Medicare bundles the two codes, CPT gives strong support to coders who want to report them together when filing a claim with a private payer. For these private payers, a trial-and-error billing would seem in order, Ferragamo says. Bill 52332 and 52005-51 (multiple procedures), and ignore the CCI and follow the CPT guidelines. But he says not all private payers will pay for both procedures.

Medicare: Use Modifier -59 Only if Separate Ureter

For Medicare, bill 52005-59 with 52332 only if a different ureter is involved, Ferragamo says. If both procedures are performed at the same encounter but are not integral parts of each other, you can bill both, he says. For example, if there is a stone on one side where the stent needs to be placed, and a renal pelvic tumor on the opposite side needing a diagnostic retrograde pyelogram, code 52332 and 52005-59.

Morgan Hause, CCS, CCS-P, coding compliance specialist for Urology of Indiana, [...]