2018 Payment Policy for Blue Light Cystoscopy

January 2018 ~

In the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, CMS adopted a number of policies, recommended by the American Urological Association (AUA), to support urologic services such as cystoscopy.

The previous CPT® coding structure for cystoscopy procedures did not identify blue light cystoscopy in the coding descriptions separate from white light cystoscopy. Consequently, the these codes do not distinguish 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.

For 2018, CMS determined that blue light cystoscopy represents an additional elective but distinguishable service as compared to white light cystoscopy that, in some cases, may allow greater detection of bladder tumors in beneficiaries relative to white light cystoscopy alone. Taking into account the additional equipment, supplies, operating room time, and other resources required to perform blue light cystoscopy in addition to white light cystoscopy, CMS is implementing 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).

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 when reported in combination with the following codes:

  • 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 – Cyustourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without ?biopsy.
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Source(s): American Association of Professional Coders (AAPC); American Urological Association; Federal Register;