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Topic: Review commonly misused urology codes

Ambulatory Surgery Reimbursement Update, August 5, 2008

Coders will sometimes come across a code that contains a specific diagnosis in the code description. Consider CPT code 52285, cystourethroscopy for treatment of female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) or urethra, bladder neck, and/or trigone. If none of these diagnoses are noted in the operative report documentation, coders should not assign this code, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, an independent consultant based in Milton, WI.

Coders also sometimes misuse CPT code 52341, cystourethroscopy with treatment of ureteral stricture (i.e., balloon dilation, laser, electrocautery, and incision). If a physician puts a stent in and dilates the urethra to make it easier to insert the guide wire, coders may be tempted to assign CPT code 52341, but this is incorrect.

Some coders use this code when they read in the operative note that the physician dilated the urethra, even though the physician does not document urethral stricture. “The coder should not select this code unless the specific diagnosis is documented,” Krauss says.

Coders commonly overuse CPT code 51700, bladder irrigation, simple, lavage, and/or installation. Coders should only report this code if the bladder irrigation is a separate, independent service, Krauss says. “You cannot assign CPT code 51700 if the bladder irrigation is included as part of another procedure or if it is a normal practice pattern,” he says.

Therefore, if the physician is removing a tumor and he or she cleans out the bladder as part of that procedure, the coder can code only the tumor removal.

Editor’s note: This topic is from the August 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.