Worried about picking the wrong cystourethroscopy code? Many coders struggle with the same problem due to multiple available options. With over one million procedures performed annually, cystourethroscopy, usually referred to as cystoscopy, is one of the most commonly performed urology procedures in the U.S.
The main problem is its billing. Many urologists and professional coders hesitate between different cystoscopy-based foreign body removal codes. This hesitation results in coding mistakes, claim denials, and revenue loss. Today, we will discuss one of these codes, CPT code 52310, in detail so you can avoid payer scrutiny.
CPT Code 52310 – Description
So, what does this code specify? CPT code 52310 refers to a urethral and bladder transurethral surgical procedure. To be more specific, it specifies a simple cystourethroscopy with the removal of a foreign body, stone, or ureteral stent. But what exactly is cystourethroscopy, and why do most providers refer to it as cystoscopy?
They are basically the same thing. Cystourethroscopy is a technical term for cystoscopy, which is the endoscopic examination of the bladder and urethra. So, what happens during this procedure?
A healthcare provider, usually a urologist, uses a cystoscope (a thin, tube-like instrument with a light and camera) to view the inside of a patient’s urethra and bladder. The primary purpose? To remove a foreign object from these organs, including a stone or stent.
Scenarios Where CPT Code 52310 is Applicable
We know that a definition is not enough to help you understand CPT code 52310’s application. That’s why we have provided the following three scenarios.
Removing a Bladder Stone
Although less common than kidney stones, urinary stones affect up to 8.8% of the U.S. population. Want to know something interesting? They are more common in men (10.6%) than in women (7.1%).
So, let’s use this information to envision the appropriate use of CPT code 52310. Suppose a 32-year-old man experiences a burning sensation during urination and pain in the lower abdomen. He also notices changes in the color of his urine.
Concerned about his symptoms, he finally consults a urologist. The healthcare provider reviews the patient’s medical history and identifies clear signs of dehydration. Suspecting a bladder stone, the urologist inserts a long, pencil-sized tube with a light and camera in the patient’s bladder through his urethra to look for it.
He then uses a specialized tool to remove the stone and bills for the procedure using the 52310 CPT code.
Ureteral Stent Removal
Did you know that urologists place approximately 92,000 ureteral stents annually to manage urinary tract blockages? These stents are normally removed by pulling a string. However, cystoscopy is necessary in some cases.
So, for the second example, let’s assume a 52-year-old man with a double-J ureteral stent arrives at a urology clinic for removal. After a thorough examination and a brief note of medical history, an anesthesiologist uses local anesthesia gel to numb the area. The urologist then inserts a cystoscope into the patient’s bladder via the urethra and fills it with sterile water to visualize the stent.
He then passes a specialized instrument through the cystoscope to remove the stent. His billing team then uses CPT code 52310 to report the procedure.
Removal of a Urethral Foreign Body
Foreign bodies in the urinary bladder are quite common. But did you know that a large variety of them are self-inserted? Men with major mental disorders make up most of these cases. In fact, according to a study, they are five times more likely to present with urethral foreign bodies.
Therefore, consider a 29-year-old schizophrenic patient who arrives at a hospital with his father. The reason for visiting? He inserted clear plastic tubing into his urethra and is now having difficulty urinating. The urologist evaluates the patient and performs a cystoscopy to discover and remove the tube.
Since the removal was simple and performed without any complication, the healthcare provider reports it with CPT code 52310.
Applicable Modifiers for CPT Code 52310
Confused about applicable modifiers? The following modifiers are justified with CPT code 52310:
Modifier 58
Did you remove a ureteral stent during the post-operative period of another procedure, such as extracorporeal shockwave lithotripsy? If the cystoscopy was staged and performed in an office setting, you can use modifier 58 with CPT code 52310 to request separate payment.
Modifier 59
Was the cystourethroscopy you performed distinct from other services on the same date? If the codes are normally bundled together, append modifier 59 to CPT code 52310 to receive separate reimbursement. However, pay attention to the NCCI edits.
If you performed the procedure on a different anatomical site or during a separate session on the same date, use more specific modifiers such as XS or XE, as these more accurately describe the distinct service.
CPT Code 52310 – Billing & Reimbursement Guidelines
The reimbursement for this code heavily depends on how well you have followed its billing guidelines. For timely payments, follow these instructions for billing cystourethroscopy.
Use CPT Code 52310 for Simple Cystourethroscopy
We all know that the key to timely approvals is using CPT codes accurately. Therefore, only choose the 52310 CPT code if you have performed a simple cystoscopy to remove one of the following from a patient’s bladder or urethra:
- A foreign body
- Stone
- Stent
Avoid using this code if the removal was complex and involved excessive bleeding. There is another code for that, CPT code 52315.
Pay Attention to the Global Period Rules
Another important thing to note is that CPT code 52310 has a 0-day global period. Therefore, all the same-day services specifically related to cystourethroscopy are included in this code. In short, you cannot use the 52310 CPT code to bill for the follow-up visits later that week.
Maintain Proper Documentation
Reimbursement for cystourethroscopy also relies heavily on how thoroughly you have documented this procedure. Therefore, make sure to include the following details in the patient’s record:
- Patient’s symptoms (e.g., burning sensation during urination or bloody or smelly urine)
- Reason for performing the procedure with an appropriate ICD-10 code
- Procedure details (e.g., simple cystoscopy, what was removed, tools, and setting)
Comply with Payer-Specific Rules
Government and commercial insurance payers may have different coverage policies for cystoscopy. Therefore, verify each payer’s rules, such as whether they cover CPT code 52310 in an office or operating room setting, bundling rules, any frequency limits, pre-authorization, and global package requirements. This step will help you submit a clean claim.
Summary
Do you now feel more confident about choosing CPT code 52310? To reiterate, this code refers to simple cystoscopy removal of a foreign object, stone, or ureteral stent. To help you avoid coding confusion, we have covered it quite comprehensively, including a detailed description and three coding scenarios.
Our blog has also outlined some guidelines to file a clean claim for the 52310 CPT code. We hope that you will know exactly when to choose this code the next time you face a cystoscopy coding scenario. But if you still cannot make up your mind, you can work with an expert to protect your revenue.
Our advice? Simply choose a cost-effective billing company with reliable urology billing services to improve your coding accuracy.
