urethral dilation with sound prior to insertion of scope for urethral stricture

mommacode

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patient has chronic urethral stricture due to morbid obesity, he has dilations done on a regular basis, The doctor states he used sounds to dilate the urethral stricture and then following this the scope is inserted and cystoscopy is performed. Does 52281 apply in this case or would the dilation have to be done through the scope? When coding the cysto and the dilation separately, the dilation is bundled but since this is the main focus of the procedure(dilating the stricture) it seems incorrect to only code the cysto. Please someone with urology coding experience help and provide link to info if you have it.
thanks
 

ckkohler

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Hello!
I work for a private urology practice ... and we do these in our ASC. Can you copy and paste a redacted note for me to look at? When you say the cysto and dilaton are bundled are you talking about 52000 and 53601 (male dilation)?
 

mommacode

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I do not have one at this time to send but yes 52000 and 53601 bundle. Basically what I am asking is 52281 referring to a "through the scope" dilation? if the dilation is done with sounds prior to insertion of the scope and then a cysto is separately done I would only be coding 52000 and not 52281, correct? If you have the answer please send me any supporting info you may have. Thanks
 

Mirandab

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Sioux Falls, SD
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included

I personally would only charge a 52000 for a dilation, followed by a cystoscope. Sometimes the scope itself will dilate the urethra and the physician will note that. Is there a mod that will unbundle the 2 codes? I think 52281 is better used when an instrument is inserted for dilation via the cystoscope.
 

TammyHF

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Wichita, KS
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52281

I would use CPT 52281 because how is a physician to perform the cystourethroscopy without being able to pass through the stricture without dilation? Just make sure you have a stricture diagnosis to support medical necessity.
 
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