Forum - Questions & Answers

Dec 30th, 2016 - Bones0321

CPT® check my answer

71 year old man comes to hospital, previously diagnosed with benign prostatic hypertrophy, urinary obstruction, experiencing increased urination, straining during urination and a continua feeling of fullness after the bladder has been emptied. Physician performs a cystourethroscopy to examine the condition of the bladder/urethra and then performs a UroLift transprostatic implant procedure using three adjustable implants.

My code is 99221/52441/52442/52442.

Sep 29th, 2017 - ChrisW   256  1 

re: CPT® check my answer

99221 - With the Initial hospital care, per day, evaluation and management be sure you have the required 3 key components

52441 – Cystourethroscopy, single implant

52442 Cystourethroscopy each additional implant

52442 Cystourethroscopy each additional implant

AMA guidelines state to use 52442 in conjunction with 54221, since this is an add on Code, you cannot use a modifier therefore; billing two separate line items would be correct or two units. Some payers require two line items while others want 2 units. Verify how the payer wants this handled, I have had claims denied as duplicate with two line items when the payer wanted 2 units.

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