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Incorrect coding and documentation errors of ASC claims for CPT code 52332
Last Modified: 11/29/2022
Location: FL, PR, USVI
Business: Part B
Did you know claims reviewed by the Recovery Auditor (RA) in 2021 for CPT code 52332 performed in an ambulatory surgical center (ASC) were among the top denials for incorrect CPT coding, incorrect modifier coding, and insufficient documentation errors?
ASC coding requires procedural information, as coded and reported by the facility on its claim, should match both the attending physician's description and the information contained in the beneficiary's medical record. RA reviewers validate the CPT or HCPCS coding and associated modifiers by reviewing the procedures affecting or potentially affecting payment.
Let’s review information on this code and how you can avoid these errors.
Claims reviewed indicated ASCs were billing this procedure code erroneously, either using the incorrect CPT code to describe the procedure being performed or incorrect modifiers were applied. When documentation was requested by the RA, either the documentation was insufficient to substantiate the claim and the code selected, or no documentation was provided at all.
Reminders:
• All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
• If documentation should be requested, be sure to respond timely with proper records to the requesting contractor.
• Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
• The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT or HCPCS code must describe the service performed.
Descriptor -- Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
CPT code 52332 describes insertion of a self-retaining indwelling stent during cystourethroscopy performed with ureteroscopy or pyeloscopy. Cystourethroscopy is a cystoscopy procedure to visually examine the inside of the bladder and urethra. This is done using either a rigid or flexible tube (cystoscope), which is inserted through the urethra and into the bladder.
Here are tips provided by the National Correct Coding Initiative (NCCI) and the American Academy of Coding Professionals (AAPC) to avoid errors when billing this procedure:
• CPT code 52332 shall not be reported to describe insertion and removal of a temporary ureteral stent during diagnostic or therapeutic cystourethroscopy with ureteroscopy or pyeloscopy. You would use a more suited code to describe this procedure (e.g., CPT codes 52320-52330, 52334-52355).
• The insertion and removal of a temporary ureteral catheter (stent) during these procedures is not separately reportable.
• These codes shall not be reported along with CPT codes 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) or 52007 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter or renal pelvis).
• CPT codes 52332 and 52005 are not separately reportable for the same ureter for the same patient encounter.
• When treating a Medicare patient, you can bill 52330 and 52332 but not 52005 with either. For example, if the urologist tried to remove or manipulate a kidney stone in the ureter, failed, and then placed the stent until performing another procedure later, they could bill 52332 with modifier -59 and 52330. Both services are billable to Medicare if the stent is left in place at the end of the procedure, rather than being used solely to aid the performance of the manipulation and then removed at the end of the procedure.
• When endoscopic visualization of the urinary system involves several regions (e.g., kidney, renal pelvis, calyx, and ureter), the appropriate CPT code is defined by the approach (e.g., nephrostomy, pyelostomy, ureterostomy, etc.) as indicated in the code descriptor. When multiple endoscopic approaches at the same patient encounter are medically reasonable and necessary (e.g., renal endoscopy through a nephrostomy and cystourethroscopy) to perform different procedures, they may be separately reported appending modifier -51 to the less extensive procedure codes. However, when multiple endoscopic approaches are used to attempt the same procedure, only the completed approach shall be reported.
• As a reminder, endoscopic procedures include all minor related functions performed at the same encounter. Although CPT codes may exist to describe these functions, they shall not be reported separately. For example, transurethral resection of the prostate includes meatotomy, urethral calibration and dilation, urethroscopy, and cystoscopy. Codes for the included procedures shall not be reported separately.
• Providers should be cautious about reporting services on multiple lines of a claim using modifiers to bypass medically unlikely editing (MUE). The MUE values are set so such occurrences should be uncommon. If a provider does this frequently for any HCPCS or CPT code, the provider may be coding units of service (UOS) incorrectly. The provider should consider contacting their national healthcare organization or the national medical or surgical society whose members commonly perform the procedure to clarify the correct reporting of UOS.
• The unit of service for a procedure describing destruction or removal of renal system calculus(i) is one. The unit of service is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, report the appropriate procedure, number of units and modifier(s). Procedures performed bilaterally in one operative session are reported as two procedures, either as a single unit on two separate lines (appending modifiers -RT and -LT) or with "2" in the 'units' field on one line. ASCs would not use modifier -50. Claims by ASCs inappropriately billed with a modifier -50 will be rejected.
Before submitting the claim for these procedures, remember:
• Review the long descriptor for the CPT or HCPCS code you are billing. The short descriptors are limited to 28 characters, and do not always capture the complete description of the procedure.
• Use the correct CPT or HCPCS code to describe the procedure(s) performed.
• Ensure your documentation supports the code(s) being billed.
• If documentation is requested, be sure to respond timely with proper records to the requesting contractor.
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