Tammy Posted Thu 31st of May, 2018 09:21:45 AM
Hello, the provider has started billing 52000 with her TLHBS which I know we can bill both with mod 59 on 52000. However is this truly separate or does it included? please let me know I have included the documentation; for cystoscopy: Attention was then turned to the cystoscopy portion of the procedure. The foley
catheter was removed. The cystoscope was assembled with a size 17 sheath and was inserted
with normal saline running. Bladder was inspected without laceration. Bilateral ureteral
orifices were visualized and immediately released ureteral jets. The cystoscope was
removed and foley catheter was replaced.
All instruments were removed from the abdomen at this time and the robot was undocked.
Pneumoperitoneum was released. 0.25% marcaine was instilled under the incisions. The
incisions were closed with 3-0 monocryl in an interrupted fashion. Sponge and needle
SuperCoder Answered Fri 01st of June, 2018 08:32:05 AM
CPT Code 52000 is designated as a "separate procedure" and would not be reported when performed as an integral component of another procedure.
When procedures are done to assure for procedure performed, it is considered inherent in the procedure. Additionally, if there is not an ICD code that can be appended to support a clinical need for the service. If there has been an injury to the ureters at the time of the surgery, then it would be appropriate to report the cystoscopy with the appropriate ICD code, such as hematuria.
As per NCCI, A cystourethroscopy (CPT code 52000) performed near the termination of an intra-abdominal, intra-pelvic, or retroperitoneal surgical procedure to assure that there was no intraoperative injury to the ureters or urinary bladder and that they are functioning properly is not separately reportable with the surgical procedure.
Hope this helps!