Cystoscopy bladder biopsy (52204) insertion of left ureteral stent (52332)

[amwittler]

A cold cup biopsy forcep was used to biopsy the lesion on the left ureteral orifice. Pinpoint fulguration was also used for hemostasis. Due to fulgurating half of the ureteral orifice and biopsying it, the surgeon stated he was concerned about inflammation causing a left ureteral obstruction. He decided to place a 6 French wriggling stent over the Guidewire on the left side without string.

52204 is bundled into 52332 unless a modifier 59 is added to 52204. What information should I be looking for to know if both codes should be reported?

 

[daniel]

When to use modifier 59:
When a cystourethroscopy with biopsy (52204) and the insertion of an indwelling ureteral stent (52332) are performed as part of the same procedure, but at different stages or involving distinct structures, modifier 59 should be used to indicate that they are separate and distinct procedural services.

Example:
If a urologist performs a cystourethroscopy with biopsy (52204) to evaluate a patient's bladder and then inserts a ureteral stent (52332) to address a ureteral obstruction, both codes (52204 and 52332) should be reported with modifier 59 to indicate that they are separate and distinct services.