Expert Answers to the Top 3 Urology Reader Questions

Fri, Feb 6, 2015 --

Reader Questions

Get helpful hints for reporting robotic laparoscopic distal ureterectomy.

Our experts handpicked three questions that represent common issues in the tough world of urology coding. Here are their suggestions on how to keep your coding accurate and your reimbursement flowing.

1. Can You Report an Open Urethral Biopsy and Cystoscopy Performed at the Same Encounter?

Question: Our urologist performed a cystourethroscopy and a urethral biopsy during the same encounter. However, the biopsy was not via the cystoscope; the biopsy was an open procedure. Our practice billed CPT® codes 52000 and 53200 with ICD-9 codes 595.2 and 223.81. The payer denied payment for CPT® code 52000 saying it was included in CPT® code 53200. How else can we bill these two procedures?

Answer: Correct Coding Initiative (CCI) edits do not bundle CPT® codes 53200 (Biopsy of urethra) and 52000 (Cystourethroscopy [separate procedure]). Both codes are correct for the mentioned scenario. Check with the payer for reimbursement policies. Append modifier 51  (Multiple procedures) if your payer instructs you to use it.

ICD-9 coding tip: Report ICD-9 code 223.81 (Benign neoplasm of urethra) for a benign tumor. If the tumor is malignant, report ICD-9 code 189.3 (Malignant neoplasm of urethra). If you do not have the pathology report yet, report ICD-9 code 239.5 (Neoplasm of unspecified nature of other genitourinary organs).

2. When Should You Use a Code for ‘History of’ Instead of an Active Cancer Diagnosis Code?

Question: Once a patient is diagnosed with bladder cancer, we perform cystoscopy on a regular basis to monitor progress. The frequency of cystoscopy gradually reduces from once every three months for the initial years to once every year in the later years. When should we start using a ‘history of bladder cancer’ code instead of ICD-9 code 239.4? What if our patient returns for a routine cystoscopy, and the test detects a new bladder tumor? The pathology report is not available yet. Which code should we use?

Answer: Report both V10.51 (Personal history of malignant neoplasm of bladder) and 239.4 (Neoplasm of unspecified nature of bladder) for the mentioned scenario where you discover a new neoplasm in a patient with a history of cancer. Use ICD-9 code V10.51 to establish medical necessity for performing the procedure and ICD-9 code 239.4 (Neoplasm of unspecified nature of bladder) if the physician spends some face to face time in an E/M service for counseling and coordination of future care. You should append modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to support reimbursement.

‘History of’ hint: ICD-9 Official Guidelines state: “When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.”

3. Does Robotic Ureterectomy Have Distinct Codes?

Question: How should we code a robotic laparoscopic distal ureterectomy and Baori ureteral flap reconstruction?

Answer: Report CPT® code 50945 (Laparoscopy, surgical; ureterolithotomy) for robotic distal ureterolithotomy. If the physician also performs the flap reconstruction portion laparoscopically, report CPT® code 50947 (Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement) or 50948 (Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement), depending on the documentation, for implanting the ureter into the bladder. There is no code for flap reconstruction, so consider reporting unlisted procedure CPT® code 51999 (Unlisted laparoscopy procedure, bladder).

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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