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Interstitial cystitis (IC), commonly known as painful bladder syndrome, is a chronic condition characterized by recurring pain in the bladder and pelvic region, often accompanied by a frequent urge to urinate. The procedure coded as CPT® 52265 involves cystourethroscopy, which is a diagnostic and therapeutic procedure that allows for direct visualization of the bladder and urethra. During this procedure, a cystoscope, which can be either rigid or flexible, is inserted through the urethra into the bladder. This enables the physician to inspect the bladder's interior, identify the ureteral orifices, and assess any areas of inflammation, scarring, or fibrosis that may be present. Additionally, any ulcerations in the bladder wall are documented. A key component of this procedure is the dilation of the bladder, which is performed to alleviate symptoms associated with interstitial cystitis. This dilation is achieved by introducing a catheter and filling the bladder with either normal saline or gas, sometimes mixed with a local anesthetic agent to enhance patient comfort. The saline or gas is retained in the bladder for a duration of 10 to 15 minutes before being removed, followed by a re-examination of the bladder and urethra using the cystoscope. It is important to note that this specific code is applicable when the procedure is performed under local anesthesia, distinguishing it from similar procedures that may utilize general or conduction anesthesia.
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The procedure coded as CPT® 52265 is indicated for patients diagnosed with interstitial cystitis (IC), which is characterized by symptoms such as:
The procedure involves several key steps to ensure thorough examination and treatment of the bladder:
After the completion of the cystourethroscopy with bladder dilation, patients may experience some discomfort, which is typically managed with local anesthetics. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include recommendations for hydration and monitoring for any unusual symptoms. Recovery time can vary, but many patients are able to resume normal activities shortly after the procedure, depending on their individual circumstances and the extent of the intervention performed.
| Short Descr | CYSTOSCOPY AND TREATMENT | Medium Descr | CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA | Long Descr | Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 52000 Cystourethroscopy (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8E - Endoscopy - cystoscopy | MUE | 1 | CCS Clinical Classification | 111 - Other non-OR therapeutic procedures of urinary tract |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Medium description changed. |
| Pre-1990 | Added | Code added. |
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