Question

Simpson undergoes a cystourethroscopy for biopsy of the ureter with radiography. Would the catheterization, endoscopic procedure, and biopsy each be reported with separate codes? Would the answer change if the secondary procedures were somewhere complicated and thus require significant additional time and effort? Explain your answer in detail.

(medical billing & coding)

Answer 1

A cystoscopy is a surgical procedure in which a tube with a small camera on the end (endoscope) is inserted into the bladder to examine the lumen of the bladder, urethra in men and women and the prostate in men. A related procedure, the urethroscopy, is done to examine the urethral lumen to look for urethral diseases or abnormalities. For the cystoscopy, the endoscope is inserted into the urethra which allows visualization of both the bladder and the urethra, thus the term cystourethroscopy. In addition to the camera, small instruments can also be passed through the endoscope that can be used to treat urinary problems. A diagnostic cystourethroscopy can be done as part of an evaluation of abnormal symptoms or laboratory findings. Cystourethroscopy can be performed with local anesthesia while the member is awake, but it can also be performed during or after pelvic surgery with regional or general anesthesia.

Coding recommendation: There may be differences based on the payer. Medicare does not recognize modifiers -RT or -LT for 52005, 52335 or 52204. Therefore, the most comprehensive code for this scenario is 52335. Because 52005 is the base code for 52335 and not billable separately if performed at the same session (endoscopy rules), it is not appropriate to break out that code. Code 52204 is also bundled by Medicare into 52335 and is not billable separately. Medicare will not pay separately for the bladder biopsy in this case.

Medical billing is a payment practice within the United States health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor's or graduate degree in medical information science and technology.