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The procedure described by CPT® Code 52320 involves cystourethroscopy, which is a minimally invasive surgical technique used to visualize and access the bladder and urethra. During this procedure, a rigid or flexible cystoscope, a thin tube equipped with a camera and light, is inserted through the urethra into the bladder. This allows the physician to inspect the bladder and ureters for any abnormalities, such as stones or tumors. The urethra is first cleansed with an antiseptic solution to minimize the risk of infection. To enhance visibility, sterile saline may be introduced into the bladder, which helps to distend the bladder wall and provides a clearer view of the internal structures. In the context of this procedure, the primary focus is the removal of a ureteral calculus, or stone, which can obstruct the urinary tract and cause significant discomfort or complications. After the bladder inspection, the ureters are catheterized to facilitate access to the stones. A guidewire is then advanced through the cystoscope into the ureter, allowing for the introduction of a grasping or retrieval device. This device is used to capture and remove the calculus from the ureter. The procedure may also involve the use of additional techniques, such as fragmentation of the stone using ultrasonic or electrohydraulic methods, although these are specifically detailed under a different CPT® code (52325). Following the removal of the stone, the ureter may be irrigated to clear any remaining fragments, and diagnostic or therapeutic solutions can be instilled as needed. The procedure concludes with the careful removal of the cystoscope, guidewire, and any catheters used during the process.
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The procedure described by CPT® Code 52320 is indicated for the following conditions:
The procedure begins with the cleansing of the urethra using an antiseptic solution to reduce the risk of infection. Following this, a rigid or flexible cystoscope is introduced through the urethra into the bladder. This allows the physician to perform cystourethroscopy, which involves visual inspection of the bladder and ureters. To enhance visualization, sterile saline may be instilled into the bladder, providing a clearer view of the bladder wall and any potential abnormalities. After inspecting the bladder, the next step involves catheterizing the ureters to facilitate access to the ureteral calculus. A guidewire is then introduced through the cystoscope and advanced through the ureter into the renal pelvis. This guidewire serves as a pathway for further instruments. A grasping or retrieval device is advanced through the cystoscope over the guidewire to reach the calculus located in the ureter. The device is then used to capture the calculus, allowing for its removal from the urinary tract. If necessary, the procedure may also involve the fragmentation of the calculus using ultrasonic or electrohydraulic techniques, although this is specifically addressed under a different CPT® code (52325). After the calculus has been retrieved or fragmented, a catheter may be advanced over the guidewire into the renal pelvis, and the ureter may be irrigated to remove any remaining calculus fragments. Additionally, diagnostic or therapeutic solutions may be instilled into the ureter through the catheter as needed. Upon completion of the procedure, the cystoscope, guidewire, and any catheters used are carefully removed.
After the completion of the cystourethroscopy and removal of the ureteral calculus, patients may be monitored for any immediate complications. Post-procedure care typically includes instructions for hydration to help flush the urinary system and reduce the risk of infection. Patients may also be advised to monitor for any signs of complications, such as persistent pain, hematuria, or fever. Follow-up appointments may be scheduled to assess recovery and ensure that the urinary tract is functioning properly. It is important for patients to adhere to any prescribed medications, such as pain relievers or antibiotics, to aid in recovery and prevent infection.
| Short Descr | CYSTOSCOPY AND TREATMENT | Medium Descr | CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS | Long Descr | Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8E - Endoscopy - cystoscopy | MUE | 1 | CCS Clinical Classification | 101 - Transurethral excision, drainage, or removal urinary obstruction |
| 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. | LT | Left side (used to identify procedures performed on the left side of the body) | 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). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | RT | Right side (used to identify procedures performed on the right side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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