Q
I need coding clarification on the following scenario: cystourethroscopy, left retrograde pyelogram, and placement of the left ureter. What are the appropriate codes for the CPT/HCPCS, radiology, surgery, and the device?
A
I would need more specific information to properly answer your question. I will assume two scenarios and will give the proper coding for each one.
In the first scenario, the patient was scheduled for a left diagnostic retrograde, possible left ureteroscopy with lithotripsy. The left retrograde revealed an upper ureteral calculus, and the decision was made to do a ureteroscopy with lithotripsy. This was performed without difficulty. A double-J indwelling stent was inserted. Assuming all procedures were properly documented, including a separate dictation for the reading of the left retrograde, the procedures should be billed as follows:
52353
52332?59
74420?26
Note that the 52005 is bundled into the 52353 and cannot be unbundled according to the CCI.
However, the coding rules state that a diagnostic test leading to a therapeutic procedure should be paid along with the therapeutic procedure. As a result, you will be denied payment for the 52005; however, you should be paid when you appeal if you have clearly stated in the documentation that the retrograde was diagnostic leading to the ureteroscopy with lithotripsy.
In addition, Medicare will pay for the reading of the retrograde only once. If there are films for the radiologist to read, he will also bill. The bill Medicare receives first is the one that will be paid.
The second scenario is the same as the first, except the patient was scheduled for ureteroscopy with lithotripsy. The retrograde was performed to outline the anatomy to facilitate insertion of the guidewire.
The billing in this scenario would be 52353 and 52332?59.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook
Disclaimer:
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.
