How To Use CPT Code 52260

CPT 52260 describes the procedure of cystourethroscopy with dilation of the bladder for interstitial cystitis, performed under general or spinal anesthesia. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 52260?

CPT 52260 is used to describe the cystourethroscopy procedure with bladder dilation for interstitial cystitis. This procedure involves the insertion of a cystoscope into the urethra and bladder to assess and treat the condition. It is performed under general or spinal anesthesia to ensure patient comfort and cooperation during the examination.

2. Official Description

The official description of CPT code 52260 is: ‘Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia.’

3. Procedure

1. The healthcare provider inserts a cystoscope into the urethra and slowly advances it into the bladder.
2. The cystoscope has a camera attached, which allows the provider to visualize the urethra, prostatic urethra (in men), and the interior of the bladder.
3. To improve the view of the bladder wall, the provider injects sterile saline water into the bladder, which also helps in bladder dilation.
4. The provider may also instill a combination of medications, such as lidocaine, sodium bicarbonate, and pentosan, to reduce bladder irritation and treat interstitial cystitis.
5. If necessary, the treatment may be repeated if the condition does not improve.
6. After instillation of fluids and a brief delay to allow the medications to work, the bladder is drained, and the instruments are removed.

4. Qualifying circumstances

CPT 52260 is performed for patients with interstitial cystitis, a chronic and painful bladder inflammation not associated with infection. The procedure is done under general or spinal anesthesia to ensure patient comfort and cooperation. It is important to note that this code should not be used if the patient received local anesthesia. Other qualifying circumstances may include the need for bladder dilation and the use of medications to treat the condition.

5. When to use CPT code 52260

CPT code 52260 should be used when performing cystourethroscopy with bladder dilation for interstitial cystitis under general or spinal anesthesia. It is important to ensure that the patient meets the qualifying circumstances mentioned above. If the procedure is performed under local anesthesia, CPT code 52265 should be used instead.

6. Documentation requirements

To support a claim for CPT 52260, the healthcare provider must document the following information:

• Patient’s diagnosis of interstitial cystitis
• Type of anesthesia used (general or spinal)
• Date of the procedure
• Details of the procedure, including the insertion of the cystoscope, bladder dilation, and medication instillation
• Any complications or additional treatments performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 52260, ensure that the procedure was performed under general or spinal anesthesia. Do not use this code if the procedure was performed under local anesthesia. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary. It is also important to consider any bundling or unbundling rules that may apply to this code.

8. Historical information

CPT 52260 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with interstitial cystitis undergoes cystourethroscopy with bladder dilation under general anesthesia to assess and treat the condition.
2. A healthcare provider performs cystourethroscopy with bladder dilation for a patient with interstitial cystitis, using spinal anesthesia to ensure patient comfort during the procedure.
3. Under general anesthesia, a cystourethroscopy with bladder dilation is performed for a patient with interstitial cystitis, and medications are instilled to alleviate bladder irritation.
4. A healthcare provider performs cystourethroscopy with bladder dilation under spinal anesthesia for a patient with interstitial cystitis, followed by the drainage of the bladder and removal of instruments.
5. For a patient with interstitial cystitis, a cystourethroscopy with bladder dilation is performed under general anesthesia, and sterile saline water is injected to improve the view of the bladder wall.
6. A healthcare provider performs cystourethroscopy with bladder dilation for a patient with interstitial cystitis, using spinal anesthesia and instilling a combination of lidocaine, sodium bicarbonate, and pentosan to treat the condition.
7. Under general anesthesia, a cystourethroscopy with bladder dilation is performed for a patient with interstitial cystitis, and the healthcare provider repeats the treatment due to the lack of improvement in the patient’s condition.
8. A patient with interstitial cystitis undergoes cystourethroscopy with bladder dilation under spinal anesthesia, and the healthcare provider documents the details of the procedure and any complications encountered.
9. A healthcare provider performs cystourethroscopy with bladder dilation for a patient with interstitial cystitis, using general anesthesia and documenting the patient’s response to the instilled medications.