Wiki Is CPT 52285 performed through the Cysto?

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ualcpc

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I have a doctor that is billing for dilatation of urethra and then doing the cystoscopy for female patient. I know that we can't bill the 52000 and 53660 cpt codes, per NCCI edits. My boss thinks we might be able to bill cpt code 52285. I think that is done through the cysto, and therefor can only bill 52000. The following dilatation wasn't performed through the cystoscopy:

She underwent cystoscopy today using the 21 French rigid sheath. Her urethral meatus was quite tight and would not accommodate the 21 French sheath. Her urethra was then dilated from 18 French to 30 French. There was resistance noted on insertion of the initial 3 sounds however after that the the urethra opened and dilated without difficulty. The 21 French rigid sheath was then inserted without any resistance.

Any thoughts?
 
Hi, ualcpc!

Based on CPT assistant October 2017 page 9, in this situatuion the cystourethroscopy should be coded as 52281, Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female. Note that the work (diagnostic cystourethroscopy), which is represented by code 52000, is included in code 52281, thus it would not be reported separately.

I hope this help!
 
Thank you Abraham, will take a look. Doesn't the dilation have to be done through the Cysto, with cpt 52281? This wasn't. The doctor actually tried to do the Cysto and had to remove it. He then dilated from 18 french sounds to 30 french sounds and then was able to insert the Cysto. I thought we could only bill the Cysto, when this is the case.
 
On this certain procedure, the dilation is done manually after the initial attempt of the doctor. Upon the unsuccessful attempt on inserting the cystoscope, the doctor used a male or female sounds dilators for the cystoscope to be inserted. After the successful dilation the doctor proceeded to the diagnostic cystoscopy. The code 55281 is a combo code for the cystoscopy procedure and the dilation. Hope this helps!
 
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