Cystoscopy: Follow CCI bundling rules to avoid trouble

Key Points

Q: I am a billing coordinator for a urology clinic that routinely wants me to bill a cystoscopy with a sling for incontinence. The reason behind it is that the physician is looking for a stitch. It is bundled according to the AUA bundling matrix. How do you feel about this?

Philosophically, a cystoscopy performed for the purpose of making sure a procedure is completed in most cases is considered a part of the greater service, especially when the cystoscopy is routinely provided. If the provider feels that the service is indeed medically reasonable and separate for this particular case, it may be billed to the private payer or Medicare, but will only be paid by Medicare upon appeal. Routine billing of a non-payable service to Medicare without documentation of medical reason other than standard of care can be considered fraudulent.

If you're asking whether you should bill a different fee for the office-based procedure as opposed to the hospital-based procedure, the answer is you may choose to, but it is not required unless you do not participate with Medicare and you are billing Medicare.

Q: When placing bilateral stents prior to a colon resection by a general surgeon, is it proper to code 52332 (stent placement) or 52005 (cannulation of the ureter)?

A: The code 52332 should be used if you are placing an indwelling stent (such as a Gibbons or double-J type). Most operative reports that we have reviewed, however, indicate the placement of ureteral catheters, which would be more appropriately coded with 52005.

Q: We are performing a cystoscopy, right ureteroscopy, laser lithotripsy of right ureteral stone, and right stent insertion. We are also performing an extracorporeal shock wave lithotripsy for a right renal stone. We are billing 52353 and 52332–59 for the ureteral stone and 50590 for the renal stone. Medicare is denying the ESWL even though we specify different diagnoses. Should we append modifier –59 to the 50590? This case involves two different stones in two different locations.

A: The CCI considers code 50590 as bundled into code 52353, but, fortunately, the CCI no longer lists 52332 as bundled into either code. This means the appropriate billing of the above scenario for Medicare would be line 1, 50590–59; line 2, 52353; and line 3, 52332 (no modifier required on date of surgery after April 1, 2007). You are correct to designate each stone treatment method with a separate diagnosis.

Q: How do I code for sacral neuromodulation therapy?