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Urology Coding Alert

Reader Question:

Modifier 59: Ensure Separate Site of Service Before Appending

Published on Wed Oct 19, 2011

Question: I have an insurance company that is not paying for a code, stating it is bundled into another code. We are billing 52353, 52352-59, and 52332-59. My doctor is doing a cystourethroscopy with ureterscopy and/or pyeloscopy with a holmium laser lithotripsy. He is then doing a basket extraction of multiple stone fragments, not just irrigating the stones out. Then he is placing a stent in the ureter. The insurance company is saying the 52352 is part of 52353. My doctor is saying this is a different procedure though it is the same anatomical site. I haven't had any problems billing this way with at least three other major insurance companies, but now one payer is denying my claims. Is that payer correct to deny the claim?Washington D.C. SubscriberAnswer: The payer is correct. As you know, the Correct Coding Initiative (CCI) bundles 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal [...]
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