NCCI Edit versus AUA Bulletin

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I have conflicting info here.

I have a Coding Brief from the American Urological Association, stating that CPT 52353 (cysto with ureteroscopy and/or pyeloscopy with litho) and 52332 (cysto with stent placement) have been combined to one CPT code of 52356 (cysto with ureteroscopy and/or pyeloscopy, with litho and placement of stent) WHEN PERFORMED AT SAME SETTING.

However, NCCI Edits say 52353 and 52332 can be billed together. Medicare is paying this combo....but commercial payors are not, saying the stent is inclusive to the 52353.

My question is...how can Medicare be paying by NCCI Edits and commercial insurers not...and why is Medicare paying when apparently 52356 should have replaced the combo?

Does any of this make sense? Good grief. Thanks for your help!
 

CARAYA

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Lexington
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52356

There maybe an edit issue with your local Medicare. My local Medicare Noridan is bundling them correctly. I would suggest using the 52356 across the board unless of course they are on separate sides. They may catch and recoupe later on.
 

nateich

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Joliet, IL
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You are correct the AMA has combined 52353 AND 52332 into one code 52356, if performed on the same side.

52353 and 52332 can be billed together when each are performed but on opposite sides.

I agree with Caraya, this may be caught and create a mess for your billing office later.
 
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