Urology Coding Alert

Question: A patient complained of gross hematuria over the past month, seeing actual blood clots. Urinalysis was positive for UTI and TNTC RBCs. He was treated with antibiotics for the UTI, and the hematuria cleared somewhat. He is now having recurrent bleeding but a CT scan gave no etiology for the gross hematuria. The scan did show an enlarged prostate. Nocturia has improved with medication. He underwent a cystoscopic examination, during which the surgeon used an Ellik device to evacuate multiple obstructing blood clots from the bladder. The surgeon then used rollerball cautery to fulgurate bleeding from the bladder neck and prostatic urethral vasculature. The physician documented enlarged prostate with obstruction, some median hypertrophy and vascularity. What procedure and diagnosis codes would be correct?

Montana Subscriber

Answer: Begin by coding the surgery as:

• 52001-59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) with modifier 59 (Distinct procedural service) and
• 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands).

Although 52001 is bundled into 52214, in a hospital setting 52001 has higher relative value units (RVUs) than 52214 and therefore, should be billed first. Append modifier 59 to 52001 for non-Medicare payers or modifier XU (Unusual non-overlapping service) for Medicare to differentiate the services.

The principal diagnosis should be N42.1 (Congestion and hemorrhage of prostate).