Summary & Overview
CPT 52305: Cystoscopic Incision or Resection of Bladder Diverticular Opening
CPT code 52305 represents a cystoscopic surgical procedure to inspect the urethra, prostatic urethra (in men), bladder interior, and ureteric orifices while incising or resecting the opening(s) of bladder diverticula. This procedure is clinically relevant for patients with symptomatic bladder diverticula or complications such as recurrent infections, urinary retention, or bladder outlet obstruction and is performed in ambulatory surgical centers, hospital outpatient departments, or inpatient surgical settings. Nationally, correct application of CPT code 52305 affects billing accuracy, utilization measurement, and appropriate reimbursement for endoscopic urologic surgery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context of the procedure, typical sites of service, and which payers are commonly relevant for coverage considerations. The publication outlines benchmarks and policy-relevant points such as common billing scenarios, expected coding groupings, and areas where documentation typically supports code selection. Data not available in the input is noted where relevant. This summary equips coding professionals, practice managers, and policy analysts with a clear understanding of what CPT code 52305 denotes and why accurate coding matters for clinical documentation, claims processing, and national utilization tracking.
Billing Code Overview
CPT code 52305 describes a cystoscopic procedure in which the provider inspects the urethra, prostatic urethra (in men), and the interior of the bladder, including the ureteric openings, using a cystoscope passed through the urethra, and incises or resects the opening of one or more bladder diverticula.
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Service type: Endoscopic genitourinary surgical procedure involving cystoscopic visualization and incision or resection of bladder diverticular ostia.
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in inpatient settings when clinically indicated.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old male presenting with recurrent lower urinary tract symptoms and urinary retention due to a bladder diverticulum identified on cystoscopy and imaging. The patient has hematuria, recurrent urinary tract infections, or incomplete bladder emptying with post-void residuals. After preoperative evaluation (history, physical, urinalysis, urine culture, and imaging such as CT urogram or ultrasound), the patient is brought to the ambulatory surgery center or hospital operating room for a transurethral cystoscopic procedure. Under general or regional anesthesia, the urologist introduces a cystoscope through the urethra, inspects the urethra, prostatic urethra, bladder interior, and ureteral orifices, locates the bladder diverticulum(s), and incises or resects the diverticular neck to improve drainage and relieve obstruction. Typical intraoperative workflow includes cystoscopic evaluation, identification of diverticulum, endoscopic incision or resection of the diverticular orifice using electrocautery or cold knife, hemostasis, possible ureteral stent placement if near an orifice, and postoperative monitoring for hematuria, infection, and urinary retention. Usual sites of service are the hospital outpatient department or ambulatory surgery center; the procedure is performed by a urologist with possible involvement of anesthesiology and nursing staff. Postoperative care includes short observation, voiding trial, analgesia, and follow-up cystoscopy or imaging as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |