cystoscopy cpt code

How To Code Cystoscopy – CPT Codes, Description & Billing Guidelines

Are you looking for the Cystoscopy CPT Code? This article describes the CPT codes and coding guidelines for this procedure. Cystoscopy can be billed for diagnostic or therapeutic procedures to treat urinary tract problems.

What is Cystoscopy?

Cystoscopy CPT Codes can be billed for a procedure that allows the specialist to see inside the bladder and urethra in detail to diagnose and treat urinary tract problems. It is also known as cystourethroscopy. This could include early cancer signs, infection, narrowing, blockage, or bleeding. Cystoscopy can be performed in several settings, including a doctor’s office or an operating room, with local or general anesthesia.

General Billing Guidelines For Cystoscopy CPT Codes

During diagnostic or therapeutic cystoscopy with ureteroscopy and/or pyeloscopy, the insertion and removal of a temporary ureteral catheter (CPT 52005) is included in CPT 52320 – CPT52356 and should not be documented separately.

CPT 52332 describes insertion of a selfretaining indwelling stent during cystoscopy ureteroscopy and/or pyeloscopy and shall not be coded to describe insertion and removal of a temporary ureteral stent during diagnostic or therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy.

  • In order to report cystourethroscopic removal of a self-retaining, indwelling ureteral stent, append CPT 52310, CPT 52315 and add modifier 58.
  • Therapeutic cystoscopy always includes diagnostic cystourethroscopy. 
  • Append CPT 52000 to report a diagnostic cystoscopy.
  • Append modifier 22(increased procedural services) when the secondary procedure requires significant additional time and effort.
  • The medical record should indicate the medical necessity for the diagnostic endoscopy.
  • The endoscopic procedure  cannot be separately reported with the non-endoscopic procedure, if performed at the same patient encounter to ensure no intraoperative injury occurred or verify the procedure was performed correctly.

Endoscopic Procedure

In the case when an endoscopic procedure is converted to an open procedure, only the open procedure may be billed as a Cystoscopy CPT Code. When an endoscopic procedure is converted to an open procedure, neither a surgical endoscopy nor a diagnostic endoscopy code shall be appended with the open procedure code.

Surgical endoscopy comprises of diagnostic endoscopy, which is not separately coded. When a diagnostic endoscopy leads to a surgical endoscopy during the same patient encounter, only the surgical endoscopy may be coded.

Endoscopic visualization of the urinary system entails several areas (e.g., kidney, renal pelvis, calyx, and ureter), the approach (nephrostomy, pyelostomy, ureterostomy, etc.) as indicated in the CPT code description defines the appropriate CPT code. When multiple endoscopic approaches at the same patient encounter are medically reasonable and necessary (renal endoscopy through a nephrostomy and cystoscopy to perform different procedures, they may be separately coded with modifier 51 to the less extensive procedure codes. However, when multiple endoscopic approaches are used to attempt the same procedure, only the finalized approach shall be coded.

Cystoscopy CPT Codes With Stent Placement

CPT 52282, CPT 52332 and CPT 52356 can be used to bill cystoscopy with stent placement. The insertion and removal of a temporary ureteral catheter (stent) in the course of these procedures are not separately coded. CPT 52332 and CPT 52005 are not separately coded for same ureter for the same patient encounter.

52282 CPT Code Description

The first cystoscopy CPT code with stent placement is 52282. This code can be used to code cystourethroscopy if the procedure is performed with insertion of permanent urethral stent. This procedure code is defined as follows:

Description: Cystourethroscopy/cystoscopy with insertion of permanent urethral stent.

52332 CPT Code Description And Billing Guidelines

The second cystoscopy CPT code with stent placement is 52332. This code can be used to bill cystourethroscopy if the procedure is performed with insertion of indwelling ureteral stent. Double J type or Gibbons are examples of this procedure. The definition is written below.

Description: Cystourethroscopy/cystoscopy (for example double-J type or Gibbons) with insertion of indwelling ureteral stent.

52356 CPT Code Description

The third cystoscopy CPT code with stent placement is 52356. This code can be billed for the cystourethroscopy procedure with pyeloscopy or/and ureteroscopy with lithotripsy including insertion of indwelling ureteral stent. Examples of this procedures are double-J type and gibbons.

Description: Cystourethroscopy/cystoscopy (for example double-J type or Gibbons) with pyeloscopy or/and with lithotripsy including insertion of indwelling ureteral stent.

Billing Guidelines & Reimbursement

Report the 52332 CPT code and add modifier 50 for bilateral insertion of self-retaining indwelling ureteral stents. Report the 52310 CPT code or the 52315 CPT code with modifier 58 to code cystourethroscopic removal of a self-retaining, indwelling ureteral stent.

Code 52332 is used to code a unilateral procedure unless otherwise specified. Report the 52332 CPT code, in addition to primary procedure/procedures, if insertion of a self retaining, indwelling stent performed during diagnostic or therapeutic cystourethroscopy with ureteroscopy or/and pyeloscopyis performed. Make sure to append modifier 51.

Example

A patient with an indwelling stent comes for removal and replacement of a ureter stent using cystoscopy. The previously placed stent was removed, and new stent was inserted.

Answer: Code CPT 52332

Only CPT 52332 should be billed when removing a ureteral stent and replacing with a new stent on the same side.

Cystoscopy CPT Codes With Urethral Dilation

CPT 52281 and CPT 52285 can be used to bill cystoscopy urethral dilation. The 52281 CPT code can be used for males and females, the 52285 CPT code for females only.

52281 CPT Code Description

The first cystoscopy CPT code with urethral dilation is 52281. This code can be billed for the cystourethroscopy procedure for males or females. Report this procedure if cystourethroscopy is performed with calibration or/and dilation of urethral stricture or stenosis. It can be with or without injection procedure for cystography and with or without meatotomy.

Description: Female or male. Without or with meatotomy. Without or with injection procedure for cystography. Cystourethroscopy/cystoscopy with calibration or/and dilation of urethral stricture or stenosis.

For example: CPT 52281 can be billed in the following situation: Patient underwent cystoscopy using the 21 French rigid sheaths. Her urethral meatus was quite tight and would not accommodate the 21 French sheath. The urethra was then dilated from 18 French to 30 French. The 21 French rigid sheath was then inserted without any difficulty.

52285 CPT Code Description

The second cystoscopy CPT code with urethral dilation is 52285. Bill this code only for females. This procedure treat urethral syndrome for female patients.

Description: Cystourethroscopy/cystoscopy for treatment of the female urethral syndrome with all or any of:

  • urethral dilation;
  • lysis of urethrovaginal septal fibrosis;
  • urethral meatotomy;
  • internal urethrotomy;
  • bladder neck;
  • lateral incisions of the bladder neck;
  • trigone; or/and
  • fulguration of polyp/polypsof urethra.

Cystoscopy CPT Code With Bladder Biopsy

The 52204 CPT code can be used to bill cystoscopy with bladder biopsy and cystoscopy multiple random bladder biopsies.

52204 CPT Code Description & Billing Guidelines

Cystourethroscopy/cystoscopy. With biopsy or biopsies.

This code includes all biopsies during the procedure and have to be coded with one unit of service. CPT 52204 includes all biopsies performed during the procedure and shall be reported with one unit of service. If a diagnostic endoscopy converted to laparoscopic or open procedure, append modifier 58 to the diagnostic endoscopy to indicate that the diagnostic endoscopy and non-endoscopic therapeutic procedures were staged or planned procedures. 

Cystoscopy CPT Codes With Ureteroscopy

There are nine CPT codes for cystoscopy with ureteroscopy. The descriptions can be found below.

52344 CPT Code Description

This code can be billed for cystourethroscopy/cystoscopy with ureteroscopy if the procedure is performed with treatment of ureteral stricture.

For example:

  • electrocautery;
  • laser;
  • balloon dilation; and
  • incision.

52345 CPT Code Description

Bill this code if the cystourethroscopy/cystoscopy procedure is performed with ureteroscopy with treatment of ureteropelvic junction stricture.

For example:

  • electrocautery;
  • laser;
  • balloon dilation; and
  • incision.

52346 CPT Code Description

Report this code if the cystourethroscopy/cystoscopy is done with ureteroscopy. The procedure needs to include treatment of intra-renal stricture.

For example:

  • electrocautery;
  • laser;
  • balloon dilation; and
  • incision.

52351 CPT Code Description

Bill this code if cystourethroscopy/cystoscopy is used for diagnostic purposes and is performed with ureteroscopy or and pyeloscopy.

52352 CPT Code Description

CPT 52352 can be billed when cystourethroscopy/cystoscopy is performed with removal or pyeloscopy and/or ureteroscopy and ureteral catheterization is included.

52353 CPT Code Description

Report this code for cystoscopy/cystourethroscopy if performed with pyeloscopy or/and ureteroscopy and with lithotripsy. Ureteral catheterization is included in this procedure code.

52354 CPT Code Description

This code can be billed if cystoscopy (also called cystourethroscopy) is performed as a procedure with pyeloscopy or/and ureteroscopy and with fulguration of ureteral or renal pelvic lesion or/and biopsy.

52355 CPT Code Description

Bill this procedure code if cystoscopy/cystourethroscopy is performed with resection of ureteral or renal pelvic tumor. It can be coded if it is done with pyeloscopy or/and ureteroscopy.

52356 CPT Code

This procedure code is the last in the list of CPT codes for cystoscopy with ureteroscopy. CPT 52356 can be billed if performed withwith lithotripsy including insertion of indwelling ureteral stent. Examples are double J type or gibbons.

Billing Guideliens

CPT 52353 have to be coded with only one unit of service per ureter regardless of the number of calculi in the ureter.  Reported m modifier 50 and one unit of service if the procedure is performed on both ureters. Don’t code it with a separate unit of service for each calculus.

Cystoscopy CPT Codes With Transurethral Resection Of Bladder Tumor

There are four CPT codes for the cystoscopy/cystourethroscopy procedure with transurethral resection of bladder tumor. Bladder tumors are reported by size.

  • 52224 CPT Code: The bladder tumor is of minor size (0.5 cm and less)
  • 52234 CPT Code: The bladder tumor is of small size (between 0.5 cm and 2 cm)
  • 52235 CPT Code: The bladder tumor is of medium size (between 2 cm and 5 cm)
  • 52250 CPT Code: The bladder tumor is of large size (larger than 5 cm)

52224 CPT Code Description

Report the cystourethroscopy/cystoscopy procedure if it is performed with fulguration. Laser or cryosurgery surgery is included. It can also be coded for or the treatment of minor size (0.5 cm and less) lesion/lesion without or with biopsy.

52234 CPT Code Description

This CPT code can also be reported for the cystourethroscopy/cystoscopy procedure with laser or cryosurgery surgery is included. Report this CPT code for small bladder tumor/tumors. The tumor size needs to be between 0.5 and 2 cm.

52235 CPT Code Description

Report this CPT code if the bladder tumor is medium size between 2 and 5 centimeter. The procedure used to treat the disease is cystourethroscopy/cystoscopy and is performed with fulguration. Laser surgery is included as well.

52250 CPT Code Description

This procedure code can be billed if the surgery was performed to treat a large bladder tumor/tumors with the cystoscopy/cystourethroscopy procedure with fulguration. Laser surgery is included.

Cystoscopy CPT Codes Insertion Of Suprapubic Catheter

CPT 52005 and CPT 52007 can be billed for on of suprapubic catheter and tube placement. The insertion and removal of a temporary ureteral catheter (stent) during these procedures is not separately coded and shall not be reported with CPT 52005 or CPT 52007. CPT 52332 and 52005 are not separately coded for the same ureter for the same patient encounter.

52005 CPT Code Description

This procedure code can be billed if cystoscopy/cystourethroscopy is performed with ureteral catheterization. It can be done without or with:

  • instillation;
  • irrigiation; or
  • ureteropyelography.

CPT 52005 is exclusive of radiologic service.

52007 CPT Code Description

This procedure code is exclusive of radiologic service. It is used to describe cystoscopy/cystourethroscopy with ureteral catheterization and performed without or with:

  • instillation;
  • irrigation; or
  • ureteropyelography.

The procedure is performed with brush biopsy of ureter or/and renal pelvis.

Cystoscopy Laser Lithotripsy

CPT 52353 and CPT 52356 can be used to describe cystoscopy laser lithotripsy. Both codes can be reported for left and right ureteroscopy if modifier RT and modifier LT are included. The procedure codes can be used to report cystoscopy with ureteroscopy for removal of ureteral stone.

52353 CPT Code Description

CPT 52353 can be billed for the cystoscopy procedure with ureteroscopy. It is performed with lithotripsy and ureteral catheterization is included.

52356 CPT Code Description

The second procedure code of cystoscopy laser lithotripsy includes the insertion of indwelling ureteral stent.

Billing Guidelines

Append modifier LT for procedures performed on the left side. Append modifier RT for right side procedures.

Do not report the 52353 CPT code in conjunction with CPT 52332. Only report the 52332 CPT code when both are performed on the same side.

When performed together on the same side, do not report the 52356 CPT code in conjunction with CPT 52332 and CPT 52353.

Cystoscopy CPT Codes With Durasphere Injection

Cystoscopy with durasphere injection can be reported with CPT 51715 and HCPCS L8606. Bill for the number of syringes of injection material used. L8606 is billed as two units if two syringes are used,

51715 CPT Code Description

This code can be billed for endoscopic injection procedure of implant material into the submucosal tissues of the bladder or/and urethra.

HCPCS L8606 Description

1 ml of synthetic implant.

Billing guidelines

Global period is zero for injection codes. Therefor HCPCS L8606 the global period is 0. CPT 51715 can only be billed if a separate E/M service is provided. Usually for a separate problem and requires separate documentation. Report modifier 25 if appropriate.

CPT Codes For Cystoscopy Hydrodistention Procedure

CPT 52260 or CPT 52265 may be reported depending on the anesthesia documented for cystoscopy hydrodistension procedure.

52260 CPT Code Description

Bill this procedure code if cystoscopy/cystourethroscopy is performed with dilation of bladder for interstitial cystitis. It can be generial or with the conduction of (spinal) anesthesia.

52265 CPT Code Description

CPT 52265 describes the cystoscopy/cystourethroscopy procedure if it is performed with dilation of bladder for interstitial cystitis with local anesthesia.

Cystoscopy Botox Injection CPT Code

The cystoscopy procedure with botox injection can be billed with CPT 52287 and HCPCS J0585. HCPCS code J0585 would be billed based on the number of units injected into the bladder and the supply of the chemo denervation agent is reported separately.

52287 CPT Code

This code describes cystoscopy/cystourethroscopy with injecton or injections for chemodenervation of the bladder.

HPCS J0585

1 unit. Injection, onabotulinumtoxina.

Cystoscopy CPT Codes Removal Of Foreign Body

Report CPT 52310 and CPT 52315 for cystoscopy removal of foreign body.

52310 CPT Code Description

Report this code for a simple cystoscopy procedure with removal of foreign body. It can also be used to code calculus or ureteral stent from urethra or bladder.

52315 CPT Code Description

Report this code for a complicated cystoscopy procedure with removal of foreign body. It can also be used to code calculus or ureteral stent from urethra or bladder.

Billing Guidelines

The code descriptors for CPT 52310 and CPT 52315 include the “separate procedure” designation. As Per CMS payment policy for procedures with the “separate procedure” designation, these codes shall not be coded with other cystoscopy CPT codes for the same patient encounter.

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