Urology Coding Alert

Question: If a patient comes in for a diagnostic retrograde (52005) and the physician decides to place a stent (52332), can I report both procedures?


Wyoming Subscriber


Answer: You should report both 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Whether or not you receive reimbursement depends on the individual carrier.

The National Correct Coding Initiative ( NCCI ) bundles code CPT 52005 into CPT 52332 , and you cannot unbundled them. The key to this situation is that the urologist performed the retrograde procedure for diagnostic purposes to visualize an obstructing stone or ureteral stricture and then decided to place the stent based on this study. The policy directives for NCCI state that "a diagnostic test leading to a therapeutic procedure should be paid along with the therapeutic procedure." Code 52005 represents the diagnostic study leading to a therapeutic procedure, the placement of the double-J stent (52332).

Payers will initially deny 52005 when you report it together with 52332, but if documentation clearly states that the retrograde was diagnostic and led to the stent procedure, you should appeal the denial. Some carriers may then pay on both procedures. Medicare carriers won't likely pay on both because in Medicare's reimbursement methodology 52005 is the base code for 52332.

Caution: If the urologist performed the retrograde to view the patient's anatomy before inserting the guidewire for the stent insertion, you cannot report both procedures. In this case, you should only report 52332 for the stent procedure.