52214 Coding Challenge: Fulguration, Then TUIBNC

Posted on 13. Sep, 2009 by Editor in Coding Challenge

Question: If my physician went to do a TUIBNC and found bleeding of prostatic varices, fulgurated them, then did the TUIBNC, can I charge the 52214 for the fulguration of the prostatic varices?

Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your urologist discovered.

First, report 52450 (Transurethral incision of prostate) for the TUIBN. Append modifier 52 (Reduced services) to show that the incision was only at the bladder neck and not the complete prostatic urethra, bladder neck to the verumontanum.

Then, you can also report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the operative session.

Skip 51 sometimes: Many payers, including Medicare, no longer require modifier 51. Processing claims electronically allows the payer to recognize when your physician performs multiple procedures and automatically make the necessary reduction in payment. Use ICD-9 diagnosis code 596.0 (Bladder neck obstruction) for the bladder neck contraction and 456.8 (Varicose veins of other sites; varices of other sites) for the prostatic varices.

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Tags: 456.8, 52214, 52450, 596.0, fulgurate, modifier 51, modifier 52, TUIBNC, urology