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amottice

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:eek:I need some clarification on cpt 52000. If according to the CCI edits it is not stated in the primary procedure that you can bill for the 52000, you are able to bill for that code correct? For example cpt 57288 cci says 52000 is not allowed...but if you were to bill 58260 with 52000-51 according to cci you can bill these two codes together right? Same as for code 58541 with 52000-51 there are no CCI edits. Can someone please clarify....thx
 
It's my understanding that if a 52000 is done to check the work of the main procedure, e.g. to make sure the surgical procedure caused no injury to the bladder, then you do not bill a 52000 separate from your main procedure. If, however, there is a diagnosis or condition separate from the main procedure that calls for a 52000, then yes, you can bill the 52000 if edits allow. I know I've read this in a Coding Alert, but I can't locate the article right offhand. Do a forum thread search on 52000. I know someone posted an article or website quote in January.

Becky, CPC
 
I agree with the response above that if the purpose of the 52000 was to verify that there was no injury to the bladder and urethra structures during the hysterectomy 58260, then there would be no medical necessity to support billing it with a modifier 51. The bladder and uterus are contiguous structures as they are part of the pelvic floor area, the GU system.

The CPT guidelines for procedures designated as Separate Procedures follow the same rules when a modifier 59 would potentially be applied. They need to be separate sessions, separate incisions, separate lesions, etc. Separate Procedures are those procedures that are routinely viewed as an integral part of another more extensive procedure. I educate my providers to tell me why it was necessary to perform the cystoscopy when it is not for post-procedures checks to confirm the success of a surgical procedure.

CMS is not always going to create an NCCI edit for every code pair with a Separate Procedure, we should know when it is appropriate to bill them with other procedures. In the case of the 57288 and 52000 code pair, an NCCI edit had to be created because over 75% of all surgeons were performing this code combination together.

Good reference article:
http://www.entnet.org/practice/upload/separate-procedure-ent-docrp.pdf
 
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