Cystoscopies, short for cystourethroscopies, are one of the most frequently performed procedures in urology. But their insurance claims are also frequently denied. This leads to an overall 17% denial rate for urology claims. The denials for cystoscopy procedures are often due to a single point of confusion: which cystoscopy code to choose for a specific surgery?
CPT code 52310 is one of those codes that are at the center of that confusion.
We have created this guide to simplify this code for you, so you don’t make any mistakes while using it. We will explain what this code covers, when you should use it, and how to bill it correctly. So, let’s start.
CPT Code 52310 – Description
CPT code 52310 is defined as:
“Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple.”
52310 is a urology billing code under the code range for ‘Urethra and Bladder Transurethral Surgical Procedures’. Therefore, it represents a surgical cystourethroscopy.
During the procedure, the physician passes a cystoscope, which is a very thin and flexible tube-like instrument with a light and camera at its end, through the urethra and into the bladder. With the help of this scope, the surgeon then locates and removes a foreign body, a bladder stone, or a ureteral stent without needing complex manipulation.
An important point to note here is that CPT code 52310 includes a complete cystoscopic inspection of the urethra, bladder mucosa, and ureteral orifices. So, you cannot use the diagnostic cystoscopy code CPT 52000 with it.
Another point that confuses some billers is the similarity of 52310 with CPT 52315. If the stone, stent, or foreign body comes out without excessive bleeding, extended operative time, or additional instrumentation, report 52310 for simple extraction. However, if the removal requires significant additional work, such as an encrusted or firmly adhered stent, CPT 52315 is the more accurate code as it represents complicated extractions.
Appropriate Use Cases for CPT Code 52310
We hope that the description helped clarify the concept. To further understand how this code is used in actual practice, let’s look at a couple of real-world scenarios in which CPT code 52310 can be used:
Scenario 1
Suppose a patient had a ureteroscopic stone treatment in the past, and a stent was placed in the ureter. Now that patient has returned to get the stent removed.
The surgery starts, and the physician inserts a cystoscope through the urethra, fills the bladder with sterile fluid to visualize the stent, and passes a grasping instrument through the scope to withdraw the stent.
Since, in this scenario, the stent was removed without any complication and via a simple cystoscopic technique, the billing department can bill the procedure with CPT code 52310.
Scenario 2
Let’s consider another scenario. Suppose a patient visits a urologist. He tells the physician that he is feeling burning during urination, discomfort in the lower abdomen, and that his urine is also discoloured. After reviewing the history and identifying signs consistent with dehydration, the physician suspects a bladder stone. Several diagnostic tests are performed such as urinalysis and a bladder ultrasound which confirm the presence, size, and location of the stone.
Therefore, the physician decides to perform a cystoscopy for bladder stone removal. He passes the cystoscope through the urethra and finds the stone. He removes it using a grasping tool without any fragmentation or manipulation. In this scenario, all the requirements for 52310 are met, so the billing department can use CPT code 52310 to file the claim.
Modifiers to Append to CPT Code 52310
The following modifiers are most frequently appended to CPT code 52310:
| Modifier | Description | When to Apply |
|---|---|---|
| 58 | Staged or related procedure during the postoperative period. | Use when the stent or foreign body is removed during the global period of a related prior procedure. |
| 59 | Distinct procedure, separate session. | Append this when 52310 is performed at a different site or during a separate session from another same-day procedure. |
Reimbursement Guidelines for CPT Code 52310
Here are some additional guidelines that will help you avoid common mistakes when reporting CPT code 52310:
Provide Detailed Documentation
Like all other claims, documentation is very important for 52310 claims. Without proper documentation, you cannot justify the medical necessity of the procedure and the circumstances in which it was performed. Here’s what you should provide with your claims:
- A clear statement confirming that the foreign body, stone, or stent was visualized, grasped, and removed.
- A description of the cystoscopic technique used.
- Findings from the complete cystoscopic inspection of the urethra, bladder, and ureteral orifices.
- Specimen disposition when a stone or fragment is sent for analysis.
- Start and stop times, along with the provider’s signature and credentials.
Check the Reimbursement Rate
The reimbursement amount for CPT code 52310 varies for each pair. Let’s discuss the amount for Medicare here.
For Medicare, the reimbursement is dependent on the Medicare Administrative Contractor (MAC) locality and facility. According to the latest Medicare reimbursement rates, the national average reimbursement amount for 52310 for facility settings is $134.61 and $298.60 for non-facility settings.
You can check the exact Medicare reimbursement amount for your MAC locality via the PFS Lookup Tool.
Final Thoughts on CPT Code 52310
Let’s wrap up this guide now. In this guide, we discussed in detail what CPT code 52310 is and how you can use it correctly in your claims. Here is a quick recap:
- 52310 represents a simple cystoscopic removal of a foreign body, bladder calculus, or ureteral stent.
- Complicated removals belong under CPT code 52315 instead.
- You cannot use 52310 and 52000 together.
- Append modifiers when necessary.
Denials are an inevitable part of medical billing. However, that doesn’t mean you cannot reduce them. With a professional billing partner, you can achieve up to a 97% claim acceptance rate. That’s why NeuraBill offers premium urology billing services at affordable rates.
