Urology Coding Alert

Question: I have two procedures that my urologist performed on the same patient within nine days, and I'm not sure how to code either one. First, he performed distal ureterectomy, ureteroscopy and ureteral reimplantation of the left ureter. Then, eight days later he had to perform a cystogram with fulguration of a bleed. Can I even report the second procedure?


Connecticut Subscriber


Answer: Even thought the second procedure falls within the global period of the first surgery, you should be able to code and be paid for both. Here's how.

First surgery: The first code you should report for the ureter surgery is 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) for the ureteral reimplantation. Then, you'll also report 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) for the ureteroscopy. For non-Medicare patients, be sure to append modifier 51 (Multiple procedures) to 52351. Medicare will append this modifier for you.

Avoid: The National Correct Coding Initiative edits bundle the resection of the ureter, represented by 50650 (Ureterectomy, with bladder cuff [separate procedure]), into 50780, so you can't report 50650 separately.

Second surgery: For the second surgery, you should first report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands). Because it appears your urologist had to perform the second surgery due to a complication, you need to append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to indicate that your physician performed surgery in the operating room to correct complications after a prior procedure.

Next, report 51600-78 (Injection procedure for cystography or voiding urethrocystography) for the cystogram your urologist performed. If the patient's medical record shows documentation that the physician not only performed the cystogram and but also interpreted the results, you should also report 74430 (Cystography, minimum of three views, radiological supervision and interpretation). Append modifier 26 (Professional component) to 74430 to indicate that you are only billing for the professional component -- the cystogram's interpretation. Answers to Reader Questions and You Be the Coder 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 31-urologist practice in Indianapolis.