Urology Coding Alert

Question: The urologist performed cystoscopy, transurethral resection of a bladder tumor, right diagnostic ureteroscopy with biopsies of the right distal ureter, right retrograde pyelogram, and right ureteral stent change. I'm getting a kick-back that 52332 bundles into 52235 and 52235 bundles into 52354 (but 52332 does not bundle into 52354). Are any modifiers warranted here or should I just be billing one or two codes? Any help would be appreciated.

Maine Subscriber

Answer: Based on the information you've provided, you should be able to report this encounter with multiple codes:

• 52354 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion) with modifier RT (Right side)
• 52235 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/orresection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) with modifier 59 (Distinct procedural service)
• 74420 (Urography, retrograde, with or without KUB) with modifier 26 (Professional services).

You can unbundle the tumor resection (52235) from the ureteroscopic biopsy (52354) as it was a distinct and separate tumor. Append either modifier 59 or modifier XS (Separate structure) to resection code 52235.

The stent insertion is not billable if the stent was inserted to promote healing of the ureteric orifice after the tumor resection. It is a little unclear from your question whether it was inserted for that reason, or if it was placed for another problem in the ureter or kidney (such as due to an obstruction). Query the provider on this before formalizing the claim. If the urologist placed the stent for any reason other than to promote healing after the bladder tumor resection, then you may can also report it with 52332. (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) and modifiers 59 and RT.

Caveat: If this patient has Medicare insurance, consider replacing the 59 modifiers with an appropriate choice from the X series of modifiers.