Wiki 52317 WITH 52224

[valerieeanderson]

My provider performed a litholopaxy and bladder fulguration at the same operative session. I am questioning if these two should be billed together since they are both in the bladder would the 52224 be an inherent part of 52317? There is a bundle but modifier is allowed. I am just really questioning if these two should be separately reportable. Any guidance is appreciated.

 

[Jessim929]

Did they switch tools to perform the procedure? (i.e. change from resectascope to bugbee - I know that's not the exact tools in this case, but you get my point) I consider if a new, separate tool was introduced to the procedure and whether or not additional surgeries would be needed if it wasn't done. I also consider how much time was indicated and/or how much dictation was spent on the procedure.

 

[thomas7331]

My provider performed a litholopaxy and bladder fulguration at the same operative session. I am questioning if these two should be billed together since they are both in the bladder would the 52224 be an inherent part of 52317? There is a bundle but modifier is allowed. I am just really questioning if these two should be separately reportable. Any guidance is appreciated.
View attachment 4823

I'm not seeing any bundling edits in the NCCI tables between these two codes - you should be able to bill both procedure and not need any modifier, unless your particular payer has different rules and/or does not follow the NCCI guidelines.

 

[daniel]

52317. N21.0
52224.51 - n32.9

This is how I see it, and as the previous code mention. No bundling issues.