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52000 vs 52281 please help!!

  1. #1
    Default 52000 vs 52281 please help!!
    Medical Coding Books
    I'm new to urology coding and am having a hard time understanding the difference between these two codes. I understand that the 52000 is just the cystourethroscopy by itself, and the 52281 is "cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis" but what I'm having a hard time understanding is what exactly "sounding" is. In alot of the doctor's op notes he says "cystourethroscopy with sounding" where he inserts a french #21, for example, and then states that he went up to a french #26 with no problem. In most if not all of the cases there is no stenosis and there's no mention of stenosis or stricture, he's just inserting a larger cystoscope. The person who was coding these before me was coding them as a 52281 because he was technically "dilating" the urethra, but the rest of the description doesn't fit (the lay description). Why would sounding be done with a cystosope, and is that considered "dilation"? At least enough to qualify for the 52281?

    Example: "A #21 French ACMI cystoscope with Foroblique lens was through the urethra and into the bladder. The urethra was sounded to #26 French with no obstruction. The bladder was entered and examined and there was a mild increased pattern of vascularity consistent with a low-grade cystitis."

    The preoperative dx was urge incontinence & post op was mild cystitis and urge incontinence. Would this be a 52000 or 52281? Any help I could get would be greatly appreciated!

  2. #2
    Ah, I just found this on the Urology Times website:

    Q In a case where it is necessary to dilate a patient in order to insert a cystoscope, we have been told that we can bill code 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female) instead of 52000 (Cystourethroscopy, separate procedure). Is this correct?

    A The short answer is no, this is not correct. The description of 52281 as read above includes specific language indicating why the dilation is performed. Therefore, a patient who does not have a clearly documented stricture or stenosis of the urethra should not be billed for code 52281. Dilating the urethera for insertion of the cystoscope for a reason other than a stenosis or stricture is considered to be part of the procedure, and therefore should not be separately reported.

    On the other hand, the code does not stipulate the method of dilation for those who have a stricture or stenosis. Thus, a patient who has one of these diagnoses and is dilated with a sound or filiforms and followers prior to cystoscopy should be reported under code 52281

    Why could I not find any info on this until right after I write a long drawn out post?

    Does this sound right to you experienced urology coders out there?

  3. #3
    Does 52281 apply when the dilation is not performed "through the scope"?

  4. Default 52281 does not apply
    If the physician isn't using the cystoscope to dilate, the appropriate codes would be 53620 or 53621 for male and 53660 or 53661 for female.

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