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Urology Coding Alert

Reader Questions:

Paint the Clot Retention Picture With 598.6

Published on Fri Oct 15, 2010

Question: Our doctor performed a cystoscopy with clot evacuation, tumor fulguration, and bladder biopsies. I checked to see what I could and could not bill together and between the doctor and myself, we came up with this: • 52001 Dx. 188.4 • 52204-51 Dx. 599.71 & V10.51. Medicare denied 52001 stating "This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated." What am I missing? Pennsylvania Subscriber Answer: Your problem could be one of two things: First, and probably most likely -- you need to attach  modifier 59 (Distinct procedural service) to 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) for the cystoscopic evacuation of the multiple obstructing bladder clots. The Correct Coding Initiative (CCI) edits bundle 52001 into 52204 (Cystourethroscopy, with biopsy[s]). This bundle has a modifier indicator of 1, so if clinical circumstances warrant, you can break this bundle, [...]
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