We are compiling all the CPT codes for capturing usage from hospitals for any time they use a holmium laser. Can you help me with the CPT codes we should be capturing from hospitals? Currently, we have 52214, 52356, 52332, and 52353.

The holmium is a very versatile laser used to do many procedures in urology, including but not limited to ablation of superficial transitional cell carcinoma, prostate resection, and lithotripsy of urinary calculi.

 To our knowledge, the laser is used most commonly in urology for services provided in conjunction with a cystoscope. However, this does not mean that the laser is not used with open procedures, nor does it mean that the laser is not used with other types of services such as laparoscopic services.

The most commonly used codes in which a holmium laser is specifically referenced are:

• 52214: Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
• 52317: Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)
• 52318: Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complex or large (over 2.5 cm)
• 52353: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy
• 52356: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)
• 52648: Laser vaporization of prostate.

You should consider that these codes, while commonly reported when a laser is used, do not require that a holmium laser is used and therefore may include cases without the use of the holmium laser.

Conversely, there are other procedures that can be performed with the laser, such as treatment of strictures at any level in the urinary tract, excision of tumors in the bladder, fulgurations, etc., but are not predominantly performed with a laser. In the end, if you want to cover all potential procedures, you will need to include a broader list of potential laser codes and then read operative notes to clarify.

Your question included code 52332, which would not require the use of a laser. We are assuming that you are looking at codes that are commonly coded with a laser procedure in your question and would therefore recommend that you leave code 52332 off the search list. Of course, all medically necessary services that are performed and documented should be coded and charged unless they are bundled by the National Correct Coding Initiative, the payer, or the CPT description.

The provider will need to determine whether other codes describing services provided are bundled, bundled but allowed to be reported with a modifier, or not bundled before reporting all services. Bundled services can be easily checked by entering all codes in the AUA Coding Today bundling matrix. The matrix calculator will explain to you exactly which codes can and cannot be billed. However, it does not sound like you should add code 52332 to your study.

What is the difference between CPT codes 74420 and 74450? I have used 74420–26 for retrograde pyelograms for my urologist. Thank you for your help. 

74420 (Urography, retrograde, with or without KUB) is the correct code to use for the initial reading of an x-ray image in which the urologist injected contrast media into the ureter to visualize the ureters and the kidneys.

You are also correct in using the –26 modifier if the procedure was performed in the hospital or in an ambulatory surgical center, in which the equipment and the technicians belong to and worked for that facility.

74450 (Urethrocystography, retrograde, radiological supervision and interpretation) is the correct code to use for the initial reading of an x-ray image in which the urologist injected contrast media into the lower urinary tract, including the bladder and urethra.