Summary & Overview
CPT 52402: Cystourethroscopy with Resection or Incision of Ejaculatory Ducts
CPT code 52402 is a key billing code for cystourethroscopy with transurethral resection or incision of ejaculatory ducts, a procedure commonly performed by urologists to treat obstructions or abnormalities in the ejaculatory ducts. This code is nationally recognized and utilized across a range of healthcare settings, particularly in surgical suites and urology operating rooms. The procedure is significant for its role in managing urinary and reproductive health, especially in cases involving calculi or other ductal issues.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and relevant benchmarks for this procedure. Readers will gain insight into policy updates, coding practices, and the clinical indications associated with CPT code 52402. The summary also highlights common modifiers and related codes, offering a comprehensive look at how this procedure is billed and reimbursed in the current healthcare landscape. This information is essential for understanding national trends in urology billing and the procedural standards for cystourethroscopy with resection or incision of ejaculatory ducts.
CPT Code Overview
CPT code 52402 describes a cystourethroscopy with transurethral resection or incision of ejaculatory ducts, a specialized urological surgical procedure. This service is typically performed in a urology operating room or surgical suite and is used to address conditions affecting the ejaculatory ducts, often related to urinary tract or prostate issues. The procedure involves the use of a cystoscope to visualize the urethra and bladder, followed by surgical intervention to resect or incise the ejaculatory ducts as clinically indicated.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult male presenting to a urology clinic with symptoms such as painful ejaculation, hematuria, or infertility. Diagnostic imaging reveals obstruction or calculi within the ejaculatory ducts. The urologist schedules a cystourethroscopy with transurethral resection or incision of the ejaculatory ducts (52402) in a surgical suite. The procedure is performed under anesthesia, allowing direct visualization and treatment of the ductal obstruction, often caused by calculi or strictures. Post-procedure, the patient is monitored for urinary function and potential complications.
Coding Specifications
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Modifiers:
- Modifier
51: Used when multiple procedures are performed during the same session. Indicates that52402is one of several procedures. - Modifier
59: Used to denote a distinct procedural service, such as when52402is performed separately from other procedures not typically performed together.
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Provider Taxonomies:
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