Wiki Billing for Guidewires?

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kathy a

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Her is an op report and would appreciate some feed back as to how you would code this.

With patient under general anesthesia and the dorsal lithotomy position the peroneal and genital area was prepped and draped in the usual sterile fashion.Patient was given 120mg gentamycin IV prior to instrumentation. Then a 22 French rigid scope was passed per urethra into the bladder. The left ureteral orifice was identified. Pollack catheter was advanced through the left ureteral orifice to the mid ureter. A glide wire was advanced to the level of the left kidney.Then attempt to advance the uteroscope along side. The guidewire was insuccessful because of narrowing of the UVJ.For that reason, the distal ureter was balloon dilated to 18-French diameter at 12 atmospheres. The uteroscope was advanced along side the guidewire. Once the UVJ was negotiated the ureter was very dilated and there were 4 mm stone fragments that were removed with the use of a basket. Then a 28cm 5 French double J stent was advanced over a guidewire to the level of the left kidney under fluoroscopic and endoscopic control. The patient tolerated the procedure well and was sent to recovery in good condition.

I know to bill for # 52320 and # 52332 and # 74480-26. Can I bill for the dilitation and the introduction of a guidewire and additional fluoroscopy for these? I have never billed for the guidewire and additional fluro. After reading a post the other day I am confused and wonder if I am missing out on additional revenue. I was thrown into this and have tried to learn on my own. Any additional help or guidance would be greatly appreciated. Thanks Kathy:confused:
 
Hi Kathy.

I would code this way:
DX RVUs
52344-LT 593.9 (ureteral stricture) 10.97
52352-LT,59 592.1 (ureteral stones) 10.48
52332-LT 592.1 (ureteral stones) 4.5

52344 Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision)

52352 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)

52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

Your op notes indicate that ureterscopy was inserted thru the ureter in baloon dilation as well as in basketing the stones.

52352 is included in 52344 as per CCI edits but it may be unbundled with a modifier 59 and use a different dx. Your notes said there's stricture in the ureter aside from the ureteral stones.

As you can see the RVUs in a facility shown above, it is 52344 that has the highest among the three. This is your primary procedure.

The 52320 you are thinking only has 7.11 RVUs and doesn't describe the ureterscopy done aside from the cystourethroscopy.

The guidewires are already included in accomplishing the procedures above. This can't be separately billed. The only CPT code that you can separately bill is 52334 (cystourethroscopy with insertion of ureteral guidewire through kidney to establish a percutaneous nephrostomy, retrograde). This was not done by your Urologist.

Lastly, per NCCI guidelines the flouroscopy is an integral component of all endoscopic procedures when performed. Hence not separately billed. I don't think you can charge the 74480 because insertion of ureteral catheter is already included in 52352.


Regina McGee,CPC,CPMA
 
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