Urology Coding Alert

Question: I can't figure out whether certain procedures are bundled, let alone how to code for them: bilateral retrograde pyelography, right uretero-nephroscopy, right stent insertion, and dilation of right ureteral orifice. Do you have any advice for me? Texas Subscriber Answer: The key to coding these procedures correctly can be found in the Correct Coding Initiative edits. Always remember that you cannot report 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) with codes 52341-52346 and 52352-52355 and no unbundling is allowed. In addition, several important codes are bundled into 52351, according to the CCI edits: 52000 Cystourethroscopy (separate procedure) 52001 Cystourethroscopy with irrigation and evacuation of multiple obstructing clots 52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service 52204 Cystourethroscopy, with biopsy 52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple 52315 ... complicated 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type). Proper billing for your prescribed scenario may include a maximum of five codes: 52351-RT for the right ureteronephroscopy including the ureteral dilation, 52332-59-51-RT for the right stent insertion, 52005-59-LT for the left cysto and retrograde pyelogram (if the study is performed for a separate and significant problem with a different diagnosis for the left urinary tract), 74420-26 if the urologist reads the retrograde films and writes a report, and 76000-26 if fluoroscopy is used. Modifier -59 is Distinct procedural service, -51 is Multiple procedures, and -26 is Professional component. Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.