Urology Coding Alert

Question: The provider performs a transrectal ultrasound (TRUS) in order to guide the insertion of CryoNeedles around the prostate. The procedure involves two freeze and thaw cycles, at which point the surgeon removes the needles and leaves a urethral warmer in situ for approximately 25 minutes. The provider then performs a direct vision urethrotomy and subsequent aspiration of the bladder and placement of a suprapubic catheter. What is the CPT^® coding? Is it the same with magnetic resonance imaging (MRI) guidance?

Nebraska Subscriber

Answer: You will report the TRUS-guided cryoablation of the prostate using 55873 (Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)). Keep in mind that the operative report exam header should typically include an indication for cryoablation, whereas the operative report may include documentation of CryoNeedles, freeze and thaw cycles, and the urethral warmer as indicated in the question.

If the urologist performs the same procedure under magnetic resonance imaging (MRI) guidance for needle placement, append modifier 52 (Reduced services) to 55873. You may then report 77022 (Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation) separately. This guidance comes directly from CPT^® Assistant (September 2019; Volume 29, Issue 9). However, keep in mind that the National Correct Coding Initiative (NCCI) bundles 55873 and 77022 with a modifier indicator of “0,” which means that they may not be reported together under any circumstances. The only chance you have of securing reimbursement for 77022 is to submit the claim on paper and include all the necessary surgical documentation and authoritative guidance (CPT^® Assistant article). However, this does not guarantee that the payer will reimburse you for both codes.

For the remainder of the surgery, report 52276 (Cystourethroscopy with direct vision internal urethrotomy) for the direct vision urethrotomy. Since code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) bundles into both 55873 and 55276 with a modifier indicator “1,” you should not report it separately.