Summary & Overview
CPT 52300: Cystoscopic Resection or Fulguration of Orthotopic Ureterocele
CPT code 52300 designates cystoscopic resection or fulguration of an orthotopic ureterocele. Performed endoscopically via a cystoscope passed through the urethra into the bladder, the procedure inspects the urethra and bladder interior and removes or destroys the prolapsed ureteral tissue on one or both sides. This code is relevant nationally for hospital-based and ambulatory surgical care of urologic congenital or acquired ureteral prolapse that impairs drainage or causes symptoms.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinical context for utilization of CPT code 52300, summarizes typical sites of service (ambulatory surgery centers and hospital operating rooms), and outlines common billing considerations tied to endoscopic urologic procedures.
Readers will find concise benchmarks and payer coverage framing, a summary of clinical indications and procedural scope, and notes on documentation elements that commonly affect coding and billing. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 52300 describes cystoscopic management of a ureterocele. The procedure entails passing a cystoscope through the urethra into the bladder to inspect the urethra, prostatic urethra (in men), bladder interior, and ureteric orifices, and to resect or fulgurate a normally placed (orthotopic) ureterocele on one or both sides.
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Service type: Endoscopic urologic surgical procedure for ureterocele resection or fulguration
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Typical site of service: Ambulatory surgery center or hospital operating room with cystoscopic/endoscopic capabilities
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents with recurrent urinary tract infections, bladder outlet symptoms, and intermittent hematuria. Imaging (renal ultrasound and voiding cystourethrogram) demonstrates an orthotopic ureterocele projecting into the bladder lumen. The urology team schedules an endoscopic transurethral procedure under general or regional anesthesia. The workflow includes preoperative evaluation and consent, anesthesia induction in the ambulatory surgery center or hospital operating room, cystoscopic inspection of the urethra and bladder, identification of the ureterocele, endoscopic incision (resection or electrocautery fulguration) of the ureterocele to relieve obstruction and restore ureteral drainage, intraoperative assessment of ureteral orifice patency, and postoperative monitoring in recovery with short observation and discharge instructions. Typical sites of service are the hospital operating room or ambulatory surgery center. This procedure is commonly performed by urologists with appropriate endoscopic training and may be used for unilateral or bilateral orthotopic ureteroceles depending on findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Used when only the physician interpretation or professional portion of a bundled service is reported separately. |