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Cystoscopy with Retrograde Pyelogram bilateral


Question

I have a question regarding the appropriate coding of these. I have been using the 52005-50 for these.

This message came up when I was trying to code it and now am wondering if I have been doing this incorrectly.

Medicare indicates that the bilateral adjustment is inappropriate for 52005 because either: (a) physiology or anatomy, or (b) the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure. Any help will be appreciated

Answer

Per CPT Assistant, May 2001, Pg 5, there are cystoscopy codes where it would not be appropriate to append a "50" modifier however there are some procedure that can be performed unilaterally where it would be appropriate to indicate that a procedure is performed bilaterally because of the extra work involved.  This list includes 52005, 52007 and 52320-52355.  If both ureters are catheterized, then it would be appropriate to assign a "50" modifier to 52005.

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Comments (1) Comments
Comment By Becky Wilson - Wed, Nov 21st, 2012 1:11 PM
when modifier 50 is added to 52005, there is no change in payment.
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