Question

A 55-year-old male presented to the hospital outpatient surgical unit for a cystoscopy. The patient's complaint was hematuria. A transurethral diagnostic cystoscopy was performed. No acute or abnormal findings were determined to be the cause of his hematuria. The patient was sent to the recovery room in good condition and was discharged later that same day.

Assign the ICD-10-CM code(s) for the first listed diagnosis. Assign the CPT code(s) to the procedure(s).

First Listed Diagnosis:

Procedure Code:

Enter the patient's CPT code(s) in APC grouper software. Review the APC grouper results and answer the following question:

To which APC does the patient group?

Answer 1

• R31.9 is a billable/specific ICD-10-CM code for hematuria that can be used to indicate a diagnosis for reimbursement purposes.
• The 2020 edition of ICD-10-CM R31.9 became effective on October 1, 2019.
• This is the American ICD-10-CM version of R31.9 - other international versions of ICD-10 R31.9 may differ.   The most controversial involves new code 52001 (Cystourethroscopy with irrigation and evacuation of clots), which includes 52000 (Cystourethroscopy [separate procedure]) and 51700 (Bladder irrigation, simple, lavage and/or instillation). Unbundling of 52001 with 52000 or 51700 is allowed under certain circumstances
• For the 2019 OPPS, CMS excluded procedures assigned to new technology APCs from being packaged into C-APCs because of a concern that packaging payment reduces claims for the new technology that are available for APC pricing. Commenters asked whether CMS’ policy applies to the “Comprehensive Observation Services” C-APC just as it would to a procedural C-APC. CMS considered the issue and did not believe the policy needs to be extended because the criteria for billing the “Comprehensive Observations Services” C-APC make it highly unlikely that a new technology service will be billed in conjunction with it.
• 53200 is the CPT code for biopsy of the urethra.
• 52310 - CPT® Code in category: Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure)
• 52204 in category: Urethra and Bladder Transurethral Surgical Procedures
• 52214 in category: Urethra and Bladder Transurethral Surgical Procedures
• 52224 in category: Urethra and Bladder Transurethral Surgical Procedures
• 52234 in category: Cystourethroscopy, with fulguration and/or resection
• 52235 in category: Cystourethroscopy, with fulguration and/or resection
• 52240 in category: Cystourethroscopy, with fulguration and/or resection
• 52250 in category: Urethra and Bladder Transurethral Surgical Procedures