Anesthesia Coding Alert

Cystoscopy the inspection of the interior of the bladder by means of a cystoscope is a common diagnostic procedure for conditions ranging from urinary tract infections and stress incontinence to follow-up of bladder cancer treatment. Although administering anesthesia during cystoscopy (or cystourethroscopy) is common, coding is not simple. By understanding the different pieces of the cystoscopy coding puzzle, you can ensure appropriate billing. Know All the Options Unlike some procedures that only have one or two applicable CPT Codes, more than two dozen codes apply to cystoscopy. They differ based on whether they report cystoscopy services alone or cystoscopy services offered at the same time as another procedure. The primary code for cystoscopy is CPT 52000 (Cystourethroscopy [separate procedure]). Other codes related to cystourethroscopy include the following:   52001-52010 for basic cystourethroscopy procedures 52204-52318 for cystoscopy with urethra or bladder procedures 52320-52355 for cystoscopy with ureter and pelvic procedures 52400-52601 for cystoscopy and associated prostate surgery. Coding for cystoscopy is sometimes confusing," says Sharon Ryan, senior coder with the physician group Anesthesia Associates of Massachusetts in Westwood. "They're often performed with a number of other procedures, and it can be hard to know how to match everything up so it's coded correctly."

Of course, providing anesthesia for multiple procedures is usually rather straightforward the anesthesiologist simply codes for the highest base procedure and the total amount of time spent on everything. But because most procedures related to cystoscopies have the same base value three coders have to go a step further to determine which procedure to report.

"Your first choice when coding anesthesia is to use the procedure with the highest number of units," explains LaSeille Willard, CPC, lead biller with the physician group Anesthesia Consultants in Frederick, Md. "But when I'm coding for three or four procedures performed at the same session and they all have the same number of base units (as is often the case with cystoscopies), I go with the code that's most descriptive of all the services that were performed."

Willard cites these examples of procedures that are commonly performed with cystoscopy, and how she determines which code to report: Cystouretheroscopy (sometimes referred to as a cysto-retrograde): Codes 52000 and 52005 are each three units, so Willard codes with 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) because it is a more in-depth code that includes cystourethroscopy as part of the procedure. Cystoscopy with stent insertion or removal: Again, these are two procedures that are three base units each. So when they are performed together, she codes with 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., [...]