UCR 186: FAQs - Bladder neck resection or TUIP; LT/RT ureteral reimplant; and Lipiodol injection coding

March 8, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network.

1. Hello all, I have a CPT coding question,

   Indications = Urinary Obstruction // Post-Op DX = Obstruction of neck of Urinary Bladder 

   Resectoscope per urethra into the bladder under direct vision. There was moderate trabeculations with no evidence of mass or stones. The bladder neck was noted to be elevated as seen on prior clinic cystoscopy. This was causing obstruction of the bladder outlet without significant prostatic hypertrophy.

   The bipolar resectoscope was used with the plasma button attachment to perform a TUIP at 5 o'clock, vaporizing the bladder neck fibers until the bladder neck was able to open properly and drain appropriately. Electrocautery was used for any small bleeding vessels and hemostasis was adequate at the end of the procedure.

   The recommended Code is: 52450, but the Coder is recommending Code: 52500.

   We're also taking Codes: 52276 & 52214 into consideration.... Please advise on what you recommend with the Rationale. Any assistance is greatly appreciated.

2. I completed a  tapered ureteral reimplant  50783 on the left and a standard Non tapered ureteral reimplant on the right 50780 - does adding LT and RT modifiers allow both codes to be billed as follows:
   50783 LT
   50780.51.RT  
   does adding R /L mods  address the bundling issue?
   
   Coders noting that 50783 includes 50780 -- however this is  2 different sides and can't bill bilateral tapered 50783.50, as only tapered one side, and bilateral reimplant 50780.50 is undercoded for the additional time and complexity of ureteral tapering 
3. Has anyone billed for bladder injection of Lipiodol before? I have a provider who resected a large bladder tumor, then injected Lipidol in and around the resection site to aid with the patient's radiation planning for invasive bladder cancer. I was thinking this may be included in the 52240, but the office is suggesting unlisted code 53899 benchmarked to 52287 or 52283. Thoughts?