Urology Coding Alert

Question: Can you offer some help regarding the use of CPT 52260 even when the pathology report from biopsies during the same session indicated patient had other chronic and acute cystitis (not interstitial cystitis). Our surgery center was evidently dinged on this by an auditor.

The patient's post-operative diagnoses were dysfunctional voiding and interstitial cystitis with Hunners' ulcer. In fact my urologist was so sure the patient had interstitial cystitis that he administered dimethyl sulfoxide (DMSO), hydrocortisone, and Heparin before the patient left the operating room and dictated that if she didn't show some remission of symptoms following this one instillation, she would be scheduled for 8 weeks of DMSO in the office. The path report diagnosis came back as acute and chronic cystitis. Given this information, are we correct in reporting 52260?

Indiana Subscriber

Answer: You are correct in reporting 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) for this procedure.

The problem: The auditor does not know that there are no specific histological findings to make a pathological diagnosis of interstitial cystitis. If the auditor says that the pathology only showed acute and chronic cystitis and not interstitial cystitis, he is incorrect and that is not a reason to deny 52260. In fact, interstitial cystitis is form of a chronic cystitis.

Your diagnosis code should be 595.1 (Chronic interstitial cystitis).

Since the urologist also performed a separate bladder biopsy you should also report 52204 (Cystourethroscopy, with biopsy[s]). Append modifier 59 (Distinct procedural service) to identify the separate nature of these two bundled procedures. The reason the urologist performed the biopsy was to rule out carcinoma in situ, an early form of bladder cancer, with specifically known pathological findings and producing symptoms similar to interstitial cystitis (hematuria, dysuria, or urinary frequency).