Urology Coding Alert

Reader Question:

Pay Attention to Gender For Proper Dilation Coding

Question: Which code should I use for a urethral dilation via a balloon dilator when the urologist does not use cystoscopy?

Tennessee Subscriber

Answer: The correct code depends on two things: whether your urologist is performing an initial or subsequent dilation and the gender of the patient. 

You should use 53600 (Dilation of urethral stricture by passage of sound or urethral dilator, male; initial) or 53601 (... subsequent) if the patient is male. If the patient is female, use 53660 (Dilation of female urethra including suppository and/or instillation; initial) or 53661 (... subsequent). 

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