Before performing an invasive procedure, healthcare providers are advised to conduct imaging. However, when it comes to billing, they cannot differentiate between the CPT codes for screening, diagnostic, and treatment procedures, and often use the incorrect code. This usually happens due to a lack of awareness about the code. Therefore, we have decided to educate you about proper billing and applications of CPT codes in our series.
In this blog post, you will discover everything about CPT code 52332, such as when the use of this code is appropriate, which modifiers are applicable, and what the medical billing criteria are that you must be aware of. Continue reading this blog if you are trying to find the answers to these questions.
CPT Code 52332 – Description
CPT code 52332 refers to a cystourethroscopy procedure with insertion of an indwelling ureteral stent. The American Medical Association (AMA) maintains this code under the range of Ureter and Pelvis Transurethral Surgical Procedures.
During this procedure, the provider inserts a thin tube with a camera and light on one end (cystoscope) into the urethra and advances it into the bladder to examine the bladder lining, the urethra, the prostatic urethra, and the ureteric apertures. The real-time imaging appears on a video monitor. Additionally, the provider implants an indwelling stent into the ureter.
The placement of stents treats ureteric blockages caused by tumors, kidney stones, or constriction of the ureteral tube. This stent helps to relieve urinary obstruction while avoiding kidney injury and ensuring appropriate urine discharge.
Scenarios Where CPT Code 52332 is Applicable
To further understand the accurate use of CPT code 52332, you can refer to the following scenarios.
Post-Surgery Complications
A 45-year-old man undergoes a complex surgery for the removal of multiple kidney stones. However, after a few days of the surgery, the patient presents with post-operative swelling and ureteral blockage. The physician conducts a cystourethroscopy and places a ureteral stent to maintain urine flow and support healing. This stent will now serve as a temporary drainage support while the ureter heals from surgical manipulation. The physician can charge for his services with CPT code 52332.
Urethral Stricture
A 56-year-old male presents with difficulty and painful urination. He usually feels like he is not able to empty his bladder and has urges to urinate a lot, even right after using the restroom. The physician carries out a cystoscopy to confirm a urethral stricture causing partial obstruction of urine flow into the bladder. He also inserts a ureteral stent to relieve obstruction and allow continuous urine drainage. Therefore, he can apply CPT code 52332 for these services.
Ureteral Obstruction
A 65-year-old male comes to your practice with severe pain in the abdomen and lower back area, with difficulty urinating. This pain is accompanied by fever, nausea, and vomiting. The CT scan reveals ureteral stones in his ureter, which require urgent intervention. The urologist performs a guided cystourethroscopy to insert a stent, allowing urine to flow from the kidney to the bladder. The provider can bill for this procedure with CPT code 52332.
Applicable Modifiers for CPT Code 52332
The following are some applicable modifiers for CPT code 52332.
Modifier 50
Modifier 50 indicates a bilateral procedure. This means an identical procedure was carried out on both sides of the body in the same session. You can apply this modifier with CPT code 52332 when a single cystourethroscopy surgery involves the placement of ureteral stents in both the left and right ureters.
Modifier 59
Modifier 59 is used to refer to a distinct procedural service. For example, when a procedure or service was performed separately and independently from other procedures on the same day. You can apply this modifier to CPT code 52332 when ureteral stent placement is performed after another procedure, e.g., stone removal, on the same service date.
Modifier LT
Suppose the physician places a ureteral stent only in the left ureter. In this case, he must apply modifier LT with CPT code 52332 to indicate that the procedure was performed on the left side of the body.
Modifier RT
However, if the physician places a ureteral stent only in the right ureter, he must apply modifier RT to CPT code 52332.
CPT Code 52332 – Billing & Reimbursement Guidelines
These billing and reimbursement guidelines can save you from claim denials for CPT code 52332.
Ensure the Correct Use of CPT Code 52332
A biller must understand the accurate use of the code before submitting it for reimbursement. For example, the insertion of a stent during a cystourethroscopy is indicated by CPT 52332. The service providers do, however, install two kinds of stents, one of which is permanently identified by this code. The other is temporary.
Urologists use it during the procedure and remove it immediately after. You can not apply CPT code 52332 in the latter scenario, where the urologist removes the stent before the patient departs. It is solely used for the installation of permanent stents.
Include Detailed Documentation
Documentation is vital for billing purposes. Insurance payers will never be able to reimburse or understand the medical necessity and details of your services if you do not communicate with them through legitimate paperwork. Thus, it must contain all the necessary information, like:
- The medical necessity of the stent insertion
- The diagnosis of a ureteral obstruction
- Type of stent used (such as the double-J type)
- Purpose of the stent
- The patient’s particular disease (e.g., kidney stones, tumors, or strictures)
- The procedure’s success
Follow Rules for Bundled Services
Can you bundle CPT code 52332 with other ureteroscopy codes? Yes, you can bundle it with ureteroscopy codes and, in some cases, with cystourethroscopy codes. According to Medicare’s National Correct Coding Initiative (NCCI), CPT code 52005 is bundled into CPT code 52332, meaning you generally cannot report them separately for the same ureter during the same encounter.
However, you must apply modifier 59 where two codes are normally bundled together but cannot be bundled due to scenarios highlighted by the American Academy of Professional Coders (AAPC).
Review Payer Policies
Even after all of this discussion about bundling codes, it is still crucial that you read the policies of your payers. Because some payers reject claims with modifier 59 or require independent billing of codes. Similarly, some payers would urge you to report bilateral treatments separately using modifiers LT and RT, while others will accept modifier 50. Therefore, we advise you to review the policies and agreements of the insurance payers before submitting a claim to them.
Conclusion
We are sure that this guide has helped you understand CPT code 52332. To sum up, this code denotes cystourethroscopy with insertion of an indwelling ureteral stent. We further explained the code’s accurate usage with practical scenarios, relevant modifiers, and key billing guidelines.
However, if you are still unsure about why and when to use CPT code 52332 in your claims, you can get expert urology billing services. It will save you from coding mistakes and resolve your reimbursement issues, such as payment delays and denials.
