Urology Coding Alert

Question: My urologist performed a cystoscopy with fulguration of bleeding points on both sides of the trigone. Should I append modifier -50 to the cystoscopy code? Will I be reimbursed for the additional work?

West Virginia Subscriber Answer: Regardless of whether you perform a cystourethroscopy bilaterally or on one side, you can't append modifier -50 (Bilateral procedure) to any cystourethroscopy code referring to the bladder.
 
Cystourethroscopy codes, such as 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands), are inherently bilateral, according to CPT - which means the fee allotted for these codes includes any additional work the physician exerts when performing the procedure on both sides. Even if the patient has bleeding at several points of the trigone, you still can bill only 52214.
 
Medicare and CPT also prohibit you from using modifier -50 with 52000, 52010, 52204-52285 and 52305-52318.  
 
- Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.