Cystoscopy is one of the most common procedures performed by urologists to detect bladder cancer. According to the 2018 Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) has finalized their proposal, to allow for a complexity adjustment when blue-light-cystoscopy (BLC) is reported on the same claim as certain cystourethroscopy CPT codes. Healthcare practices and medical coding companies need to get prepared to follow and implement the new CPT coding changes and guidelines coming up in 2018. Properly understanding these changes and their relative implications, and being prepared to implement them are crucial for urologists to optimize reimbursement.
In general, cystoscopy involves the insertion of a small optic instrument or thin tube (also called cystoscope), with a light and a lens or a small video into the urethra and bladder, which allows the urologist to examine the bladder wall for suspicious lesions. Traditionally, white light cystoscopy has been the “gold standard” for diagnosing bladder cancer. However, this diagnostic tool has limitations and does not fully detect or highlight hard tumors in the bladder. By utilizing blue-light-cystoscopy technology (also known as fluorescence cystoscopy), the tumor cells will fluoresce or appear as “bright blue” tissue in the bladder. This can help urologists detect even a small tumor that is difficult to see and make it much more obvious, thus enabling more precise tumor removal.
Blue-light cystoscopy can be typically performed only after conducting white light cystoscopy as BLC requires specialized imaging equipment to view cellular uptake of the dye that is not otherwise used in white light cystoscopy procedures.
CPT Coding for Cystoscopy Procedures
The current CPT coding structure for cystoscopy procedures does not identify blue-light cystoscopy in the coding descriptions as separate from white light cystoscopy. Therefore, the current CPT codes for cystoscopy do not differentiate cystoscopy procedures involving only white light cystoscopy from those involving both white and blue light cystoscopy, which require additional resources compared to white light cystoscopy alone.
According to the Centers for Medicare & Medicaid Services (CMS), blue-light cystoscopy represents an additional elective but distinguishable service, when compared to the other and in some cases may allow better or higher detection of bladder tumors in beneficiaries relative to white light cystoscopy alone. Given the additional equipment, operating time and other resources required to perform blue light cystoscopy in addition to white light cystoscopy, for the year 2018, CMS created a new HCPCS Level II C-code to describe blue light cystoscopy and to allow for a complexity adjustment to APC 5374 (Level 4 Urology and Related Services) for certain code combinations in APC 5373 (Level 3 Urology and Related Services).
The new code pair combination of procedures described by HCPCS Level II code – C9738 – Adjunctive blue light cystoscopy with fluorescent imaging agent (List separately in addition to code for primary procedure) and cystoscopy procedures assigned to APC 5373 are now eligible for a complexity adjustment. The CPT codes include –
| 52204 | Cystourethroscopy, with biopsy(s) |
| 52214 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands |
| 52224 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy |
The code pair combination of HCPCS Level II code C9738 with CPT code 52204, 52214, or 52224 will qualify for a complexity adjusted payment from APC 5373 to APC 5374. The combination of procedures described by new HCPCS Level II code C9738 and cystoscopy procedures assigned to APC 5374 and APC 5375 does not qualify for a complexity adjustment.
The effectiveness and benefits of using Blue Light Cystoscopy (BLC) with Cysview for improved detection and management of bladder cancer is widely recognized. It is a positive move that the CMS has created a separate payment code and additional payment for Blue Light Cystoscopy with Cysview procedure as this should result in more patients having access to BLC with Cysview and also increase equality of care in the management of bladder cancer patients.
The benefits of using blue-light-cystoscopy technology for improved detection and management of bladder cancer is widely recognized. The idea of creating a separate payment code and additional payment for BLC procedure will result in more patients having access to this procedure and would increase the quality of care in the management of bladder cancer patients. Hospitals can increase the efficiency of their urology medical coding documentation as well, with assistance from reliable medical billing and coding companies.
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