Urology Coding Alert

Question: We’ve seen several cystourethroscopy cases enter our coding workflows over the past year, and we’ve run into denials with some of the kidney stone removal claims. Many of the procedures in question involve cystourethroscopy with lithotripsy, access sheaths, or steerable ureteral catheters.

Could you provide advice on how to report these procedures?

Revenue Cycle Insider Subscriber

Answer: Certainly! Regardless of whether you’re new to urology coding or have been coding the procedures for years, cystourethroscopy coding can be a bit tricky, but Revenue Cycle Insider is here to help.

The CPT^® code set features several cystourethroscopy codes, as well as ones that include lithotripsy services. An example of these codes is 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)).

On the other hand, you’ll report HCPCS Level II code C9761 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)) when the provider performs the procedure with a steerable ureteroscope.

Important: You should also note that a steerable urethral catheter and a navigable access sheath are not the same thing. According to the AHA Coding Clinic^® for HCPCS, Volume 26, Issue 1, “The use of a sheath is not considered a steerable ureteral catheter.”

You’ll assign 52356 when the urologist performs a cystourethroscopy with lithotripsy and inserts a stent, but you’ll use C9761 when the provider uses a steerable ureteroscopic catheter. “It would be inappropriate to report HCPCS code C9761 … when the components of the code descriptor are not performed and a steerable, vacuum assisted ureteral catheter is not utilized,” per AHA Coding Clinic^® for HCPCS.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC