Urology Coding Alert

Question: How do I code a fistulogram? The operative note states that the urologist performed a cystoscopic examination and passed a 5 French ureteric catheter over a guidewire into an opening in the posterior bladder wall. Then, he injected radiopaque contrast through the ureteric catheter and obtained films. The physician saw the contrast fill the sigmoid colon and opacify the complete left colon. The urologist diagnosed a colovesical fistula. How do I code this procedure?

Florida Subscriber

Answer: First, report 52000 (Cystourethroscopy [separate procedure]) for the cystoscopy. Then, report 20501 (Injection of sinus tract diagnostic [sonogram]) since your urologist also performed the fistulogram. Finally, if your urologist documented that he interpreted the fistulogram, you should also report 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation) for that service. Append modifier 26 (Professional component) to represent the urologist only interpreting and reporting the results.