Urology Coding Alert

Question: The urologist marked codes 52332 and 52204 on the paperwork for a procedure; both codes apply to the patient’s left ureter. We billed both codes with modifier XU. The payer denied the claim. What is your advice?

Indiana Subscriber

Answer: Current coding edits bundle codes 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double­ J type)) and 52204 (Cystourethroscopy, with biopsy(s)). The associated modifier indicator is 1, which means you can only report the codes on the same claim under appropriate circumstances and with supporting documentation.

In your situation, the urologist performed both procedures on the same site: the left ureter. Because of this, you should not report the codes separately if the placement of the stent was to protect the ureteral orifice during the bladder biopsy near the left ureteral orifice. In this latter scenario, placement of the stent becomes part of the procedure (52204). Therefore, only report code 52204 and don’t include 52332.

Exception: However, if the urologist also treated left hydronephrosis, and the JJ stent was placed for treatment of the hydronephrosis (drainage), then you may bill for both procedures. In this latter case scenario, appeal any denial with complete documentation indicating the placement of the stent represented a treatment of the hydronephrosis.