Urology Coding Alert

Question: Can we bill for 76000 in conjunction with 52005? I know 76000 is designated a separate procedure. But is it OK to bill it in the specialty of urology? In the past, we got paid sometimes, sometimes not. Now, however, it is being denied by everyone. Should we just stop billing 76000?

Arkansas Subscriber

Answer: Nothing in CPT or in the Correct Coding Initiative (CCI) says not to bill 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) with 52005(cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyleogrpahy, exclusive of radiologic service). However, if you are experiencing denials, your only alternative is to add modifier -59 to the fluoroscopy code, as long as the documentation indicates a separately identifiable reason for the fluoroscopy. It may be that payers are denying payment because it is not obvious to them why additional visualization (e.g., fluoroscopy) is medically necessary in addition to the visualization available through the scope. Check with your payer representative. If that is the problem, your denials could probably be reversed.

That said, it must be noted that 76000 is a radiology code. At one time, Medicare and many other payers did pay the urologist the professional component (76000-26). Since 1999, however, 76000 has been denied as a separate service included in many urological procedures such as 52005 and urodynamics under fluoroscopic control. Some Medicare carriers only pay 76000-26 when used with video-urodynamics performed on an outpatient basis.