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Urology Coding Alert

Reader Questions:

Urethrotomy and Biopsy Offer 3 Code Solutions

Question: The physician did a direct vision internal urethrotomy and then did a biopsy of the urethra. Can I report these two codes (52276 and 52204) together with a 59 modifier? I know I can use the modifier, but should I? Virginia Subscriber Answer: The Correct Coding Initiative (CCI) does bundle 52204 (Cystourethroscopy, with biopsy[s]) into 52276 (Cystourethroscopy with direct vision internal urethrotomy). But as you mention, you can break the bundle with a modifier under the proper clinical circumstances. In the scenario you describe, you have three coding options based on the clinical scenario your urologist explains in his operative report. Option 1: If your urologist did a biopsy of another area of the urinary tract, such as the bladder or prostatic urethra, report both 52276 for the visual urethrostomy and 52204 for the biopsy. Append modifier 59 (Distinct procedural service) to 52204 to break the bundle. Option 2: [...]