Urology Coding Alert

Hint: Code 595.1 isn't the only medically necessary diagnosis CPT Codes 52260 and 52265 specify interstitial cystitis in the description - and that's the condition for which urologists are most likely to use it, says Heather Smolinski, CPC, coding specialist with Genito-Urinary Surgeons in Toledo, Ohio. 
 
But that doesn't mean 595.1 is the only diagnosis code you can link to CPT 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) and 52265 (... local anesthesia) and get paid, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for urology of Indiana LLC, a 22-urologist practice in Indianapolis.
 
"There is no requirement for a specific IC diagnosis code to bill 52260 and 52265," he says. "Often these are done for patients in the course of ruling out IC and may be billed for the symptoms of IC."

Besides 595.1, acceptable diagnosis codes that support the medical necessity of 52260 and 52265 often include 599.7 (Hematuria), 788.1 (Dysuria) and 788.41 (Urinary frequency).