Urology Coding Alert

Question: Our urologist performed a cystourethroscopy with urethral biopsy. The biopsy was performed via open approach, not through the cystoscope. We coded 52000 and 53200 using 595.2 and 223.81. The payer disallowed 52000 as bundled. Do you agree with this adjudication? Is there a more appropriate single code for this procedure?

New Hampshire Subscriber

Answer: You are billing correctly with 53200 (Biopsy of urethra) for the open urethral biopsy as the primary procedure. You should then bill 52000 (Cystourethroscopy [separate procedure]) for the diagnostic cystoscopic examination. Attach modifier 51 (Multiple procedures) if your payer requires that modifier. According to the latest Correct Coding Initiative (CCI) edits, 52000 and 53200 are not bundled. However, in your case the payer seems to have its own bundling rules, bundling these two codes. You have to follow your payers’ policies for correct coding.

Diagnosis help: Prior to the pathology report, use 239.5 (Neoplasm of unspecified nature of other genitourinary organs). For a benign tumor append 223.81 (Benign neoplasm of… urethra) and for a malignant tumor append 189.3 (Malignant neoplasm of urethra).