Marisela Posted Tue 24th of September, 2019 15:33:53 PM
The physician marked 52332 cysto/stent with 52204 cysto/biopsy which we billed with an XU mod; carrier is stating that 52204 is completely integral to 52332. Based on the following excerpt, do you feel we can appeal this or is it truly relevant? "We introduced a 23-French cystoscopy with 30-degree lens under direct vision into the bladder. We then noted a small capacity bladder with multiple red lesions consistent with cystitis. The left ureteral orifice was then accessed with a sensor wire and noted to be small in caliber. We then were able to pass the wire all the way up to the level of the kidney. We then advanced a 5-French open-ended catheter over the wire to the mid ureter and then removed the wire. ..... otherwise normal retrograde pyelogram, but given the fact that the patient was septic, we readvanced the wire all the way up to the renal pelvis and then push pulled the open-end out, then advanced a 6x26 double-J stent over the wire. We then visualized the cure in the kidney and then deployed the stent with a curl at the ureteral orifice. It was noted that after we were able to access the ureter that papillary looking tissue was emanating from the left ureteral orifice. At this time, we changed over to a rigid biopsy grasper and grasped some of this tissue by the ureteral orifice and sent it off for pathological analysis."
SuperCoder Answered Wed 25th of September, 2019 06:11:25 AM
Thanks for your question.
There is CCI edit between these codes (52204 and 52332) and the modifier indicator for code 52204 is 1, which means code 52204 can be billed with code 52332 only under appropriate circumstances.
But in this scenario, both the procedures have been performed on the same site i.e. left ureter. So, code for biopsy is inclusive and should not be reported separately.
Please feel free to write if you have any question.