Urology Coding Alert

Question: Our surgeon performed several procedures during a single ASC session: cystourethroscopy, bilateral retrograde pyelograms, bilateral ureteral cytology, left ureteroscopy, insertion of a double-J stent, transurethral resection prostatic fossa biopsies, and transurethral resection of bladder neck lesion. Would the proper coding be 52332, 52204, 74420, and a selection from 52234-52240 depending on the lesion size?

Rhode Island Subscriber

Answer: Most of the codes you suggest for this encounter are correct. You’ll want to report the following:

• 52204-XS (Cystourethroscopy, with biopsy(s); Separate structure)
• 52005 (Cystourethroscopy, with ureteral catheter­ization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) for the cystoscopy and retrograde pyelogram and ureteral cytology, bundled into several of the other codes and not payable in this scenario
• 74420-26 (Urography, retrograde, with or without KUB; professional component) if your physician separately interpreted the pyelogram and documented your reading in the medical records
• 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic)
• The appropriate choice from 52234 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)), 52235 (… MEDIUM bladder tumor(s) (2.0 to 5.0 cm)), or 52240 (… LARGE bladder tumor(s)) for the transurethral resection of the bladder neck lesion, depending on its size.

There are multiple bundling issues and edits with the above CPT^® codes. Therefore, check the CCI for these edits. The most appropriate coding for the above scenario including all edits would be: 52234, 52204-XS, 74420-26, and 52351. All other codes are involved in bundling edits and not billable as such in this clinical scenario. That includes 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)), which you asked about specifically. It is bundled into several of the other codes and not payable in this clinical scenario.