Urology coding demands precision, a comprehensive understanding of urology procedures, different insurance payers’ requirements, and staying current with the updates in the coding systems.
Missing a single element will topple your house of cards, making it challenging to keep your urology practice running.
Thus, we have dedicated this guide to urology coding. It will discuss the commonly used urology CPT codes and coding guidelines so you can submit clean claims and collect rightful reimbursements.
Urology CPT Codes for Incision Procedures on the Bladder
CPT Code 51020 – Abnormal Tissue Removal Through Fulguration/ Radioactive Substance
You may report this CPT code for urology when the urologist performs a surgical incision into the patient’s urinary bladder or accesses abnormal tissue by creating an opening in the bladder. Besides, the provider destroys the abnormal tissue by placing a radioactive substance in the bladder cavity or with fulguration.
The provider may also adopt the fulguration technique to destroy benign growth, including papillomas or polyps within the urinary tract. Contrarily, the radiation therapy is often used to treat some prostate cancers.
CPT Code 51065 – Removal of a Ureteral Calculus, or Stone
When the conservative methods fail to expel the stone, the urologist removes the stone or ureteral calculus using a calculus basket extractor and electrohydraulic or ultrasonic fragmentation. Generally, a urologist will undertake this procedure if the stone has caused hematuria (blood in urine), persistent and intense flank pain, infection, nausea and vomiting, and obstruction leading to hydronephrosis.
Thus, if the individual patient’s condition demands stone removal using an extractor or fragmentation technique, you may bill the urology CPT code 51065.
Urology CPT Codes for Laparoscopic Procedures on the Bladder
CPT Code 51990 – Surgical Suspension of the Urethra by Placing Multiple Sutures
You bill this urology CPT code when the healthcare practitioner performs surgery to suspend the urethra by placing multiple sutures and then stitching the urethra to the surrounding tissue.
A urologist will often perform this surgery with a laparoscope, i.e., a minimally invasive surgical technique utilizing a thin tube-like instrument with a camera at one end.
CPT Code 51992 – Surgical Suspension of the Urethra by Placing a Single Graft
It is another surgical procedure for the suspension of the urethra. However, the urologist will perform it by placing a single graft at the bladder’s junction and the urethra. You may report this service with urology CPT code 51992.
Besides, the provider may order this procedure for patients with an inability to control urine or for treating stress incontinence.
Urology CPT Codes for Vesical Neck & Prostate Surgical Procedures
CPT Code 52400 – Cystourethroscopy
It is a diagnostic procedure code that covers cystourethroscopy for patients with conditions like stress incontinence and urinary tract infections and for the follow-up of bladder cancer treatment.
This procedure may take 5-10 minutes to complete, and it covers the interior inspection of the patient’s bladder, ureteric, and urethra openings using a cystoscope.
You can use urology CPT code 52400 for reimbursements. Apart from diagnosing diseases, this procedure is also performed to remove tumors and stones in the bladder.
CPT Code 52601 – Transurethral Resection of the Prostate (TURP)
You can use the urology CPT code 52601 when the surgeon performs the TURP procedure. Surgeons perform this procedure by inserting a resectoscope through the urethra to remove a prostate portion.
Besides, this CPT code covers several other urology services, including urethral dilation, meatotomy, and cystoscopy. The reason? Because these urology procedures are intrinsically included in the TURP and are not allowed to be billed individually.
CPT Code 52648 – Transurethral Resection
Urologists may perform this procedure to treat benign prostate hyperplasia (BPH), which generally occurs in elderly and middle-aged men.
This condition causes several urinary issues, such as incomplete emptying of the bladder, infection, straining weak flow, urgency to pass urine, etc. You can use the urology CPT code 52648 to bill this procedure.
Urology Coding Guidelines
In this section, we will discuss the urology coding and billing best practices to help you streamline your practice’s revenue cycle:
Use Technology with Human Expertise
Undoubtedly, electronic health records (EHRs) are great tools for charting and coding, but they cannot replace the critical human element in code selection.
Simply put, you should not take for granted the many benefits that come with EHRs, such as coding accuracy and elimination of data entry errors.
However, your human coders can ensure coding specificity, which is integral for faster and higher reimbursements. Thus, if you are using EHRs, we recommend you add a human QA step to your coding workflow to ensure each claim meets the highest standards of coding precision, accuracy, and specificity.
Train Your Staff On Urology Coding Guidelines
Urology demands nuanced patient care, and its coding and billing requirements are not much different. Thus, you must invest in regular staff training so they are well-versed in urology documentation and coding guidelines.
When providers and billing teams work collaboratively, it is easier to navigate the coding complexities, leading to reduced denials, higher payments, and a steady cash flow.
Ensure Accurate Coding
When it comes to urology coding guidelines, efficiency is the secret ingredient to ensure financial success. Thus, we advise you to become well-versed in the four primary coding categories to streamline the coding process. These are discussed below:
E/M Codes
The evaluation and management codes will help you bill for physician and non-physician encounters, consultations, and hospital visits.
Procedure Codes
You can report these urology CPT codes to bill for various urology services, including treatments, surgeries, and diagnoses.
Add-on Codes
These codes will help you report urology services rendered in addition to the primary procedure. You can find these codes within the “+” symbol in the CPT manual. Correct usage of the add-on codes will help you enhance accuracy and ensure comprehensive billing against the rendered services.
Modifier Codes
These codes are critical for reporting modifications or changes in the primary procedures. You must ensure appropriate usage of modifiers to avoid denials and penalties.
Bottom Line
The commonly used CPT codes for urology include 51020 for abnormal tissue removal, 51065 for removal of a stone or ureteral calculus, 51990 and 51992 for surgical suspension of the urethra, 52400 for cystourethroscopy, 52601 for TURP, and 52648 for transurethral resection. We hope the urology coding and billing guidelines we shared will level up your billing game and ensure a healthier revenue cycle. However, if you don’t think handling coding and billing workflow in-house is your cup of tea, you can outsource urology billing services to professionals like MediBill MD.
Frequently Asked Questions
