Urology Coding Alert

Question: My doctor performed a cystoscopy, dilatation of the ureter, right retrograde pyelogram, ureteroscopy, and placement of a right double-J stent. I need help coding the procedures. Is the dilation bundled into the other procedures?

Alaska Subscriber

Answer: If the dilation of the ureter is to facilitate the passage of an instrument such as a ureteroscope through a narrow but otherwise normal ureter, this dilation becomes an integral part of the procedure, and you should not bill it separately. Bill only for the ureteroscopy using 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic).

Alternative: If the dilation is performed because of the presence of a ureteral stricture, then bill a ureteral dilation code -- 52341 (Cystourethroscopy; with treatment of ureteral stricture [eg, balloon dilation, laser, electrocautery, and incision]) or 52344 (Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision]) -- with the diagnosis of ureteral stricture (593.3, Stricture or kinking of ureter).

In this case do not also bill for the ureteroscopy (52351) as the Correct Coding Initiative (CCI) bundles the ureteroscopy code 52351 into both 52341 and 52344, and these edits cannot be bypassed with any modifier. Also report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [eg, Gibbons or double-J type]) for the stent insertion and 74420-26 (Urography, retrograde, with or without KUB; professional component) for the interpretation and supervision of the retrograde pyelogram if separately documented.