Urology Coding Alert

Review descriptors to know which CPT^® codes are needed.

Interstitial cystitis is a condition that’s tricky to diagnose, and it can be just as confusing to report, which can lead to several coding misconceptions. Luckily, Revenue Cycle Insider has gathered a few common fallacies to alleviate your coding confusion.

Uncover the truth behind the interstitial cystitis coding myths below.

Myth 1: Interstitial Cystitis Is an Acute Condition

Interstitial cystitis is a chronic inflammation or irritation of the bladder wall, which means that the patient is experiencing the condition long-term. The inflamed tissue can lead to bladder scarring or stiffening if untreated.

Two of the most common interstitial cystitis symptoms include frequently feeling the need to urinate, but with smaller volumes than most people. This is because the stiffening bladder wall cannot expand to hold as much urine as it could previously. Patients can also experience chronic pelvic pain and pain or discomfort as the bladder fills.

Urologists usually rule out other conditions like bladder cancer, bladder infections, and sexually transmitted diseases (STDs) before diagnosing the patient with interstitial cystitis. Simultaneously, some urologists may document the condition as:

• A Hunner’s ulcer
• Panmural fibrosis of bladder
• Submucous cystitis

If any of the conditions listed above are documented, then you can report an interstitial cystitis code.

The ICD-10-CM code set features two interstitial cystitis codes that differ in whether the patient is also experiencing hematuria (red blood cells in the urine):

• N30.10 (Interstitial cystitis (chronic) without hematuria)
• N30.11 (Interstitial cystitis (chronic) with hematuria)

“For patients with interstitial cystitis, you should look for documentation of hematuria, as code selection is impacted by the presence of hematuria,” explains John Piaskowski, CPC-I, CPMA, CUC, CRC, CGSC, CGIC, CCC, CIRCC, CCVTC, COSC, specialty medicine auditor at Capital Health in Trenton, New Jersey, and AAPC consultant and committee chair.

Myth 2: You Don’t Need Additional Diagnosis Codes

You can debunk this myth by examining parent code N30.- (Cystitis), which instructs you to “use [an] additional code to identify [the] infectious agent.” The codes you’ll look to include categories B95.- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere) through B97.- (Viral agents as the cause of diseases classified elsewhere).

Myth 3: Report Anesthesia Services Separately From Cystourethroscopy Testing

A urologist performs cystourethroscopy to visualize the bladder and fills the bladder with water, also known as hydrodistention, to test for interstitial cystitis. The urologist uses hydrodistention to see if the patient has mucosal cracking and bleeding, which are suggestive signs for an interstitial cystitis diagnosis. The cystourethroscopy procedure requires the use of anesthesia, and the type of anesthesia affects your coding.

You’ll assign 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia) when the urologist performs the cystourethroscopy with general or spinal anesthesia. On the other hand, if the provider places the patient under local anesthesia for the procedure, you will report 52265 (… local anesthesia).

However, you do not need to assign an anesthesia code, such as 00910 (Anesthesia for transurethral procedures (including urethrocystoscopy); not otherwise specified), along with 52260 or 52265 since the anesthesia administration is inherently included in the cystourethroscopy procedure.

According to the National Correct Coding Initiative (NCCI) edit pairs, 00910 is a column 2 code for 52260 and 52265 with a modifier indicator of “0.” The “0” indicator means you cannot override the edit and unbundle the services to report them separately.

Myth 4: Use Multiple Codes to Report Bladder Instillation and Lavage

Urologists use bladder instillation and lavage to treat interstitial cystitis, and while two services are listed here, only one CPT^® code is needed to report the procedure. You’ll assign 51700 (Bladder irrigation, simple, lavage and/or instillation) to report the bladder instillation and lavage procedure to treat the patient’s condition.

Procedure explanation: The term “lavage” in 51700’s descriptor is a flushing of the patient’s bladder, whereas “instillation” means the urologist is putting the drug into the bladder as treatment.

The typical interstitial cystitis treatment is instilling the bladder with dimethyl sulfoxide (DMSO), sodium hyaluronate, heparin/lidocaine, sodium bicarbonate, or other “bladder cocktails,” Piaskowski explains. While you will assign only one CPT^® code for the procedure, you’ll also need to assign the appropriate HCPCS Level II codes for the medication.

Examples of HCPCS Level II codes for reporting the bladder cocktail include:

• J1212 (Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml)
• J1644 (Injection, heparin sodium, per 1000 units)
• J2270 (Injection, morphine sulfate, up to 10 mg)
• J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg)

During this procedure, your urologist will use a catheter to fill the patient’s bladder with the bladder cocktail. This cocktail will stay in the patient’s bladder for different amounts of time, depending on the patient’s tolerance of the drugs. The bladder will then be drained through the catheter.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC