Question Procedure ?

RebeccaB

Guru
Messages
169
Best answers
0
Op report reads pouchoscopy with biopsy of ureter..Pouchoscopy was performed, the ureteral pouch anastomic site demonstrated papillary change inflammatory appearing tissue which was biopsied x 3
Would this be 44386 ? Not at all sure what to use as a diagnosis code
Any help much appreciated
Thanks
Rebecca
 

cpc2007

Guru
Messages
103
Best answers
0
I found a great reference about this topic from the AUA. Here is what they say about endoscopies into the pouch for a urinary diversion procedure:

Another patient had a cystectomy with a continent diversion. How do I bill for an endoscopy into the pouch?
A. You would bill CPT code 52000 when endoscopy procedure is being done through a pouch.
Guidelines have changed for 2016; Because cutaneous urinary diversions utilizing ileum or colon serve as functional replacements of a native bladder, endoscopy of such bowel segments, as well as performance of secondary procedures can be captured by using the cystourethroscopy codes.

The CPT guidelines also support the AUA's stance. At the start of the cystourethroscopy section in CPT it states "Because cutaneous urinary diversions utilizing ileum or colon serve as functional replacements of a native bladder, endoscopy of such bowel segments as well as performance of any secondary procedures can be captured with cystourethroscopy codes. For example, endoscopy of an ileal loop with removal of ureteral calculus would be coded with cystourethroscopy with removal of ureteral calculus (52320)."

Based on those guidelines, in this case since your physician is inserting a scope into the pouch and taking a biopsy of the pouch at the anastomosis site where the ureter joins the pouch, I would go with 52204. Viewing the pouch as a "replacement bladder" this would be similar to taking a biopsy in the bladder at the site where the ureter attaches in a patient who hasn't had removal of their bladder and creation of a pouch.

For the diagnosis, I would consider waiting for your final path to see if you can get a more specific code for that "inflammatory appearing tissue" and/or report signs/symptoms that prompted the physician to examine the pouch in the first place if you don't have a definitive diagnosis in the end.

I hope that helps :) - have a great night!

Kim
www.codingmastery.com
 
Top