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Urology Coding Guidelines


Article-Urology-Coding-Guidelines

Medical coding is a complex process requiring medical specialty-wise coding skills and relevant experience. Coding gets much more complicated when it comes to urology coding. The Centers for Medicare & Medicaid Services (CMS) understands the complexities of urology coding and publishes urology coding guidelines from time to time. This article contains in-depth urology coding guidelines applicable for the year 2022 onwards.

For these urology coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual published by CMS in 2022. Note that most of the payers follow Medicare coding guidelines with unique modifications, so you need refer to payer-specific urology coding guidelines for appropriate coding.

Urology Coding Guidelines

  • Insertion of a urinary bladder catheter is a component of the global surgical package. Urinary bladder catheterization (CPT codes 51701, 51702, and 51703) is not separately reportable with a surgical procedure when performed at the time of or just prior to the procedure. Additionally, many procedures involving the urinary tract include the placement of a urethral/bladder catheter for postoperative drainage. Because this is integral to the procedure, placement of a urinary catheter is not separately reportable.
  • Cystourethroscopy, with biopsy(s) (CPT code 52204) includes all biopsies during the procedure and shall be reported with one unit of service.
  • Some lesions of the genitourinary tract occur at mucocutaneous borders. The ‘CPT Manual’ contains the integumentary system (CPT codes 10000-19999) and genitourinary system (CPT codes 50000-59899) codes to describe various procedures such as biopsy, excision, or destruction. A single code from 1 of these 2 sections of the ‘CPT Manual’ that best describes the biopsy, excision, destruction, or other procedure performed on 1 or multiple similar lesions at a mucocutaneous border shall be reported. Separate codes from the integumentary system and genitourinary system sections of the ‘CPT Manual’ may only be reported if separate procedures are performed on completely separate lesions on the skin and genitourinary tract. Modifier 59 or XS should be used to indicate that the procedures are on separate lesions. The medical record should accurately describe the precise locations of the lesions.
  • If an irrigation or drainage procedure is necessary and integral to complete a genitourinary or other procedure, only the more extensive procedure shall be reported. The irrigation or drainage procedure is not separately reportable.
  • The CPT code descriptor for some genitourinary procedures includes a hernia repair. An HCPCS/CPT code for a hernia repair is not separately reportable unless the hernia repair is performed at a different site through a separate incision. In the latter case, the hernia repair may be reported with modifier 59 or XS.
  • In general, multiple methods of performing a procedure (e.g., prostatectomy) cannot be performed at the same patient encounter. (See general policy on mutually exclusive services.) Therefore, only one method of accomplishing a given procedure may be reported. If an initial approach fails and is followed by an alternative approach, only the completed or last uncompleted approach may be reported.
  • If a diagnostic endoscopy leads to the performance of a laparoscopic or open procedure, the diagnostic endoscopy may be separately reportable. Modifier 58 may be reported to indicate that the diagnostic endoscopy and non-endoscopic therapeutic procedures were staged or planned procedures. The medical record must indicate the medical necessity for the diagnostic endoscopy. However, if an endoscopic procedure is performed as an integral part of an open procedure, only the open procedure is reportable. If the endoscopy is confirmatory or is performed to assess the surgical field (‘scout endoscopy’), the endoscopy does not represent a separate diagnostic or surgical endoscopy. The endoscopy represents the exploration of the surgical field, and shall not be reported separately with a diagnostic or surgical endoscopy code. If an endoscopic procedure is performed at the same patient encounter as a non-endoscopic procedure to ensure no intraoperative injury occurred or verify the procedure was performed correctly, the endoscopic procedure is not separately reportable with the non-endoscopic procedure.
  • If an endoscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical endoscopy nor a diagnostic endoscopy code shall be reported with the open procedure code when an endoscopic procedure is converted to an open procedure.
  • Surgical endoscopy includes diagnostic endoscopy, which is not separately reportable. If a diagnostic endoscopy leads to a surgical endoscopy at the same patient encounter, only the surgical endoscopy may be reported.
  • When multiple endoscopic procedures are performed at the same patient encounter, the most comprehensive code accurately describing the service(s) performed shall be reported. If several procedures not included in a more comprehensive code are performed at the same endoscopic session, multiple HCPCS/CPT codes may be reported with modifier 51. (For example, if renal endoscopy is performed through an established nephrostomy with biopsy, fulguration of a lesion, and foreign body (calculus) removal, the appropriate CPT coding would be CPT codes 50557 and 50561-51, not CPT codes 50551, 50555, 50557, and 50561.) This policy applies to all endoscopic procedures, not only those of the genitourinary system.
  • CPT code 51700 (Bladder irrigation, simple, lavage, and/or instillation) is used to report irrigation with therapeutic agents or as an independent therapeutic procedure. It is not separately reportable if bladder irrigation is part of a more comprehensive service, such as to gain access to or visualize the urinary system. Irrigation of a urinary catheter is included in the global surgical package. CPT code 51700 shall not be misused to report irrigation of a urinary catheter.
  • CPT codes 51784 and 51785 describe diagnostic electromyography (EMG). When EMG is performed as part of a biofeedback session, neither CPT code 51784 nor 51785 shall be reported unless a significant, separately identifiable diagnostic EMG service is provided. If either CPT code 51784 or CPT code 51785 is reported for a diagnostic electromyogram, a separate report must be available in the medical record to indicate this service was performed for diagnostic purposes.
  • When endoscopic visualization of the urinary system involves several regions (e.g., kidney, renal pelvis, calyx, and ureter), the appropriate CPT code is defined by the approach (e.g., nephrostomy, pyelostomy, ureterostomy, etc.) as indicated in the CPT descriptor. When multiple endoscopic approaches at the same patient encounter are medically reasonable and necessary (e.g., renal endoscopy through a nephrostomy and cystourethroscopy) to perform different procedures, they may be separately reported appending modifier 51 to the less extensive procedure codes. However, when multiple endoscopic approaches are used to attempt the same procedure, only the completed approach shall be reported.
  • Endoscopic procedures include all minor related functions performed at the same encounter. Although CPT codes may exist to describe these functions, they shall not be reported separately. For example, transurethral resection of the prostate includes meatotomy, urethral calibration and/or dilation, urethroscopy, and cystoscopy. Codes for the included procedures shall not be reported separately.
  • When urethral catheterization or urethral dilation (e.g., CPT codes 51701-51703) is necessary to complete a more extensive procedure, the urethral catheterization/dilation is not separately reportable.
  • Ureteral anastomosis procedures are described by CPT codes 50740-50825, and 50860. In general, they represent mutually exclusive procedures that are not reported together. If one type of anastomosis is performed on one ureter, and a different type of anastomosis is performed on the contralateral ureter, the appropriate modifier (e.g., LT, RT) should be reported with the CPT code to describe the service performed on each ureter. For example, the procedure described by CPT code 50860 (Ureterostomy, transplantation of ureter to skin) is mutually exclusive with the procedures described by CPT codes 50800-50830 (e.g., Ureteroenterostomy, Ureterocolon conduit, Urinary undiversion) unless performed on contralateral ureters, in which case anatomic modifiers should be reported.
  • CPT codes 53502-53515 describe urethral repair codes for urethral wounds or injuries (urethrorrhaphy). When a urethroplasty is performed, codes for urethrorrhaphy shall not be reported in addition since ‘suture to repair wound or injury’ is included in the urethroplasty service.
  • CPT code 78730 (Urinary bladder, residual study) is a nuclear medicine procedure requiring the use of a radio-pharmaceutical. This CPT code shall not be used to report the measurement of residual urine in the urinary bladder determined by other methods.
  • CPT code 52332 (Cystourethroscopy, with insertion of the indwelling ureteral stent) (e.g., Gibbons or double-J type)) describes insertion of a self-retaining indwelling stent during cystourethroscopy with ureteroscopy and/or pyeloscopy and shall not be reported to describe insertion and removal of a temporary ureteral stent during diagnostic or therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy (e.g., CPT codes 52320-52330, 52334- 52355). The insertion and removal of a temporary ureteral catheter (stent) during these procedures is not separately reportable and shall not be reported with CPT codes 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;) or 52007 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of the ureter and/or renal pelvis). CPT codes 52332 and 52005 are not separately reportable for the same ureter for the same patient encounter.
  • Prostatectomy procedures (CPT codes 55801-55845) include cystoplasty or cystourethroplasty as a standard of surgical practice. CPT code 51800 (Cystoplasty or cystourethroplasty...) shall not be reported separately with prostatectomy procedures.
  • CPT code 50650 (Ureterectomy, with bladder cuff (separate procedure)) shall not be reported with other procedures on the ipsilateral ureter. Since CPT code 50650 includes the ‘separate procedure’ designation, the Centers for Medicare & Medicaid Services (CMS) does not allow additional payment for the procedure when it is performed with other procedures in an anatomically related area.
  • The code descriptors for CPT codes 52310 and 52315 (Cystourethroscopy, with the removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure...)) include the ‘separate procedure’ designation. Per CMS payment policy for procedures with the ‘separate procedure’ designation, these codes shall not be reported with other cystourethroscopy CPT codes for the same patient encounter.
  • Fluoroscopy (CPT code 76000) is an integral component of all endoscopic procedures when performed. CPT code 76000 shall not be reported separately with an endoscopic procedure. (CPT code 76001 was deleted January 1, 2019.)
  • Cystourethroscopy and transurethral procedures include fluoroscopy when performed. CPT codes describing fluoroscopy or fluoroscopic guidance (e.g., 76000, 77002) shall not be reported separately with a cystourethroscopy or transurethral procedure CPT code. (CPT code 76001 was deleted January 1, 2019.)
  • A ureteral stent is commonly inserted at the site of an anastomosis of a ureter and another structure in order to maintain the patency of the ureter. A ureteral stent is also often inserted into a ureter if the ureter is incised during a procedure (e.g., nephrectomy, cystectomy, ureteral anastomosis). With these procedures, insertion of the ureteral stent is integral to the procedure and is not separately reportable. For example, CPT code 50605 (Ureterotomy for insertion of an indwelling stent, all types) shall not be reported with CPT codes describing cystectomy, urinary diversion, or ureteral anastomosis for insertion of a ureteral stent to maintain patency at the site of a ureteral anastomosis.
  • Pelvic exenteration procedures (CPT codes 45126, 51597, 58240) include extensive removal of structures from the pelvis. Providers/suppliers shall not separately report codes for the removal of pelvic structures (e.g., colon, rectum, urinary bladder, uterine body and/or cervix, fallopian tubes, ovaries, lymph nodes, prostate gland).
  • CPT code 50435 (Exchange nephrostomy catheter… and/or fluoroscopy) and all associated radiologic supervision and interpretation) describes exchange of a percutaneous nephrostomy catheter, including a diagnostic nephrostogram. CPT codes 50430 and 50431 should not be reported separately with 50435.
  • CPT codes 52317 and 52318 describe litholapaxy (crushing/fragmentation and removal) of calculus in the urinary bladder. These codes may be reported for crushing/fragmentation with the removal of calculi originating de novo in the urinary bladder. These codes shall not be reported for crushing/fragmentation and removal of calculi in the urinary bladder that result from a procedure to remove, manipulate, and/or fragment calculi higher up in the urinary tract.

We referred National Correct Coding Initiative (NCCI) policy manual published by CMS in 2022 for these urology coding guidelines. Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services.

We can assist you in receiving accurate insurance reimbursement for urology services from government and private payers. To know more about our urology billing services, email us at: info@medicalbillersandcoders.com or call us: 888-357-3226.

Reference: National Correct Coding Initiative (NCCI) Policy Manual

CPT Codes: Copyright 2022 American Medical Association.

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