Urology Coding Alert

Question:In the evaluation of gross hematuria the urologist first evacuated multiple obstructing clots from the bladder and then, after cystoscopic examination when the bladder interior could be clearly viewed, he fulgurated several bleeding sites secondary to radiation cystitis. There was no biopsy involved. CCI edits say 52001 is included in 52214, but the bundle can be broken with modifier 59. When would it be appropriate to add modifier 59 to 52001?Virginia SubscriberAnswer:This clinical scenario would be the time when you should add modifier 59 (Distinct procedural service). Since the irrigation usually does take sufficient time to perform and is a separate part of this overall procedure you should consider the following coding for your clinical scenario:52001-59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) for the clot evacuation52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration.