I have a case where a physician performed a cystouretroscopy with ureterscopy on the left side 52351 and performed the biopsy/ fulguration on the right side only bring ing me to cpt code 52354. However, it was coding 52351 LT and 52354 RT which creates a bundle edit? Can you bill it that way to the insurance company or should only 52354 RT/LT be listed only? I have posed this questions several times to somone else and I don't think we are coding this correctly?
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Wiki cysto w ureterscopies
- Thread starter dcas76
- Start date
cgallimore
Networker
Well, according to the CCI edits, you cannot unbundle the 52351 from 52354 even with a modifier. I think since you only did a biopsy/fulguration on one side, you can only bill 52354-RT. Doing the diagnostic on the other side is unfortunately just bundled 
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.Thanks Cindy for your response. This is exactly what I thought and I am not the coder who bills it that way but often times this edit will appear as a bundle and when i asked my colleague about she stated that she would drop it to paper to get it out the door. I think he/she is over coding and than it creates a rejection and more work for myself, because I am todl to file appeals and exhaust all avenues before writing it off. Well, I just have to keep my mouth shut because I am the newbie!!!
FTessaBartels
Guest
Medicare or NOT?
Urology is NOT my specialty, but ...
Ingenix does allow the bilateral -50 modifier, or the RT/LT modifiers, on 52351 and 52354. CMS does not.
If the patient is not covered by Medicare (or another carrier that follows CMS edits), then I believe you CAN code as your coder has indicated.
Hope that helps.
F Tessa Bartels, CPC, CEMC
Urology is NOT my specialty, but ...
Ingenix does allow the bilateral -50 modifier, or the RT/LT modifiers, on 52351 and 52354. CMS does not.
If the patient is not covered by Medicare (or another carrier that follows CMS edits), then I believe you CAN code as your coder has indicated.
Hope that helps.
F Tessa Bartels, CPC, CEMC