Urology Coding Alert

Question: A patient has hematuria. The physician performs a ureteroscopy on the left side with a retrograde pyelogram. A retrograde pyelogram is also performed on the right side. A bladder biopsy is performed on the left bladder wall. Is this the correct coding: 52335 (LT), 52005-59, -51 (RT) and 52204-59, -51?

North Carolina Subscriber

Answer: Based on the CPT description as well as CCI bundling edits, the ureteroscopy (52335), the retrograde ureteropyelography (52005), and the bladder biopsy (52204) are bundled with 52338 (cystourethroscopy, with ureteroscopy and/or pyeloscopy [includes dilation of the ureter and/or pyeloureteral junction by any method]; with biopsy and/or fulguration of lesion). Use 52338 for the procedures you describe in your question.

If the urologist performs the radiologic portion of the retrograde pyelography (74420, urography, retrograde, with or without KUB), report it separately. If this service is performed in the hospital, append modifier -26 (professional component) to 74420.

You can check this information by looking up these codes in the Medicare Correct Coding and Payment Manual under correct coding edits or in the National Correct Coding Index. Also, refer to Appendix A in your CPT 2000 book for a complete description of modifier -59 (distinct procedural service). You can use it only in certain instances, and youll need good documentation to back up the use of this modifier.