How To Use CPT Code 52400

CPT 52400 describes a specific procedure known as cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 52400?

CPT 52400 is a code used to describe a procedure called cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds. This procedure involves the inspection of the bladder, urethra, prostatic urethra, and ureteric openings using a cystoscope, which is inserted through the urethra. The physician examines the urethra and may perform various treatments to alleviate urinary obstruction, such as incising the valves or mucosal folds, fulgurating the tissue, or resecting excess tissue to enlarge the urethral passage.

2. Official Description

The official description of CPT code 52400 is: ‘Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds.’

3. Procedure

1. The physician inserts a cystoscope into the urethra and slowly advances it into the bladder.
2. The cystoscope is equipped with a camera that allows the physician to view the interior of the bladder on a monitor.
3. The physician examines the urethra and may inject sterile saline water into the bladder to improve visibility.
4. If congenital posterior urethral valves or obstructive hypertrophic mucosal folds are present, the physician may choose to incise, fulgurate, or resect the tissue to alleviate urinary obstruction.
5. After the procedure is complete, the physician withdraws the instruments and drains the bladder.

4. Qualifying circumstances

CPT 52400 is performed on patients with congenital posterior urethral valves or obstructive hypertrophic mucosal folds that cause urinary obstruction. The procedure is typically done under anesthesia. The physician must assess the patient’s condition and determine the need for cystourethroscopy with incision, fulguration, or resection. The procedure is performed by a qualified physician who has the necessary expertise and training in cystourethroscopy.

5. When to use CPT code 52400

CPT code 52400 should be used when a physician performs cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves or obstructive hypertrophic mucosal folds. This code is appropriate when the procedure is performed to alleviate urinary obstruction caused by these conditions. It is important to ensure that the documentation supports the medical necessity of the procedure and the specific condition being treated.

6. Documentation requirements

To support a claim for CPT 52400, the physician must document the following information:

• Patient’s diagnosis of congenital posterior urethral valves or obstructive hypertrophic mucosal folds
• Medical necessity for cystourethroscopy with incision, fulguration, or resection
• Details of the procedure performed, including any incisions, fulguration, or resection
• Any complications or adverse events that occurred during the procedure
• Post-procedure instructions or recommendations
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 52400, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the procedure performed and the medical necessity for the treatment. CPT code 52400 should not be reported with other codes unless additional procedures or services were performed during the same encounter that are separately billable. It is essential to review the payer’s guidelines and policies regarding billing and reimbursement for CPT 52400.

8. Historical information

CPT 52400 was added to the Current Procedural Terminology system on January 1, 2001. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician performs cystourethroscopy with incision of congenital posterior urethral valves in a newborn baby with urinary obstruction.
2. A urologist performs cystourethroscopy with fulguration of obstructive hypertrophic mucosal folds in a patient with recurrent urinary tract infections.
3. A pediatric urologist performs cystourethroscopy with resection of congenital posterior urethral valves in a child with urinary obstruction.
4. An adult patient with urinary obstruction undergoes cystourethroscopy with incision and fulguration of obstructive hypertrophic mucosal folds by a urologist.
5. A physician performs cystourethroscopy with resection of congenital posterior urethral valves in a teenager with recurrent urinary tract infections.
6. A urologist performs cystourethroscopy with fulguration of obstructive hypertrophic mucosal folds in an elderly patient with urinary retention.