Q
What code can we use to show that a procedure was done robotically? When we first started doing robotic surgeries, we were using S2900 but had problems with the insurance company paying for the actual procedure when we added this code.
A
Code S2900—Surgical Techniques Requiring Use of Robotic Surgical System (list separately in addition to code for primary procedure)—is a valid procedure code in 2009. However, use of the code for Medicare is not allowed. In fact, all Healthcare Common Procedure Coding System codes beginning with an S are not valid for Medicare billing.
Because no specific Medicare code distinguishes the use of robotics in a surgical procedure and no such code exists within the Current Procedural Technology manual, you have the choice of using the laparoscopic procedure for that particular surgery or the appropriate unlisted code for that family of codes unless directed otherwise by the payer.
As you have noted, the S2900 is problematic with many payers, especially those following Medicare rules. There are a few paying for the code, and it is valid. At this point, the only advice we can give is to experiment and/or negotiate with your private payers.
Q
We would like to know whether one can bill the insertion of a double-J stent (52332) and also bill for a retrograde pyelogram and interpretation of the pyelogram (74420 and 74430, respectively), or are they bundled together?
A
The simple answer is that they all are bundled together and cannot be billed separately. If you look at the bundling edits found on http://AUAcodingtoday.com/ under 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [eg, Gibbons or double-J type]), you will find that 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) is included in 52332 and can never be unbundled.
If the primary procedure, as planned and performed, was to insert the double-J stent and you performed the retrograde to facilitate the procedure, then you should not charge for the retrograde since it is a component or an integral part of the primary procedure. In that case, the bundling edit is correct.
However, if your original intent was to perform the retrograde pyelogram and you decided to insert the double-J stent after the diagnostic study was completed, you should be paid for both procedures. Medicare rules state that you should be paid for a diagnostic procedure that leads to a therapeutic procedure. In that case, theoretically, you should charge for the insertion of the stent (52332), the reading of the retrograde (CPT 74420), and the retrograde (52005) with the –58 modifier for Medicare or possibly the –59 modifier for private payers.
Actually, by definition, either modifier is correct. However, payment will be denied by the computer and the extra payment may not be worth the extra time and effort required to appeal the denials.
The code 74430 (Cystography, minimum of three views, radiological supervision and interpretation) was not part of your description of the procedure performed and should not be charged in either circumstance.
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.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook.
Mark Painter is CEO of PRSUrology SC in Denver.
