Avoid Double Billing by Understanding Bundling Rules
Question: I’m new to urology coding and I’m having trouble understanding the bundling rules for procedures and components. For example, the urologist performed a diagnostic cystourethroscopy that turned into a therapeutic procedure with a ureteroscopy, and they used balloon dilation to treat a ureteral stricture. Could you help me code this encounter? Louisiana Subscriber Answer: Codes that include multiple components typically also include basic services. If we take a look at the example you presented, you’d assign 52344 (Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)) because the code covers the diagnostic and therapeutic cystourethroscopies with ureteroscopy and ureteral stricture treatment via balloon dilation. In this case, the physician most likely noticed something during the diagnostic cystourethroscopy that warranted changing the procedure to a therapeutic cystourethroscopy. According to CPT® guidelines, “Therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy always includes diagnostic cystourethroscopy with ureteroscopy and/or pyeloscopy.” This means that you’ll assign the code that includes each of the services performed rather than reporting a diagnostic cystourethroscopy (52320 [Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus]) and 52344. In that case, you’d be double billing for the diagnostic cystourethroscopy. Expert tip: When presented with a procedure report, double-check the documentation to make sure the physician wrote down all of the services they performed. Compare this list of services against the codes and descriptors listed in the CPT® code book to assign the correct code or codes for the physician’s work. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
