Urology Coding Alert

Question: According to Correct Coding Initiative (CCI) edits, 52005 is a component of column 1 code 52204, but coders may use a modifier to differentiate between the services the urologist provides. So when can we report both CPT Codes? The cases I am specifically looking at are:

• Patient had cystoscopy. Urologist placed a catheter and performed washings, and then removed the catheter and did a cold cup biopsy.

• Urologist performed a cystoscopy with a biopsy, and then placed a catheter.

Can I unbundle the codes in these cases?

Oregon Subscriber

Answer: You are correct that CCI bundles 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service) into the codes for transurethral resection of a bladder tumor (TURB) as well as 52204 (Cystourethroscopy, with biopsy[s]). You can bypass this edit and report both CPT codes using modifier 59 (Distinct procedural service) under the appropriate circumstances.

Example: If the urologist performs a cystoscopy and retrograde pyelogram as a diagnostic study along with the TURB or biopsy codes, you may bill for both. If the cystoscopy and insertion of a ureteral catheter is to protect the ureter during the resection when the physician anticipates that a TURB or biopsy may involve the ureteral orifice, this procedure becomes an integral part of the resection or biopsy, and therefore, you should not bill separately for it.

In the two cases you describe -- obtaining urine from the upper tract for cytology via cystoscopy and ureteral catheterization and then performing a bladder biopsy -- report the following codes:

• 52204 for the bladder biopsy whether the urologist obtains one or more biopsies

• 52005-59 for the upper tract studies.