Urology Coding Alert

Question: One of my urologists performed the following: cystoscopy, bilateral retrograde pyelography, cystolithopaxy (using a combination Holmium laser litho and mechanical cystolithopaxy), transurethral incision of prostate, and fulguration of two bladder tumors. The bladder stone was 3.0 cm, and the bladder tumors were each 0.4 cm. What would be the best way to code this?

Florida Subscriber

Answer: Report 52318 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large [over 2.5 cm]) for the fragmentation of the bladder stone. Report 52450 (Transurethral incision of prostate) for the incision of the prostate gland.
 
For the small bladder tumors, report CPT 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy).   Report 74420-26 (Urography, retrograde, with or without KUB; professional component) if the urologist made a formal reading of the pyelogram. This reading should mention the size of the ureteral catheter used, the type and amount of contrast used, and a full description of the collecting system and drainage tract - such as a radiologist might have reported in his reading of the films.
 
Warning: Do not code separately for the cystoscopy and retrograde pyelography (52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or urteropyelography, exclusive of radiologic service) because they are bundled into 52224 and 52318.