Use Modifier 59 to Report Separate Biopsy and Stent Placement Procedures
Question: A urologist used cold cup biopsy forceps to biopsy a lesion on the left ureteral orifice. Pinpoint fulguration was also used for hemostasis. Due to fulgurating half of the ureteral orifice and capturing a biopsy, the surgeon stated they were concerned about inflammation causing a left ureteral obstruction. They decided to place a 6 French wriggling stent over the guidewire on the left side without string. What codes will I report for this encounter? Illinois Subscriber Answer: Assign 52204 (Cystourethroscopy, with biopsy(s)) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) with modifier 59 (Distinct procedural service) appended to 52332 to indicate the stent placement was a separate and distinct procedural service performed during the biopsy. The National Correct Coding Initiative (NCCI) edits bundles 52204 into 52332, which means the NCCI considers the biopsy an inherent portion of the stent placement during a cystourethroscopy procedure. However, since the urologist was already performing the biopsy and decided to place the stent during the initial procedure to address a ureteral obstruction, you may report the codes separately with modifier 59 appended to 52332 to show the services are separate and distinct. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
