For the CPT 2024 code set, a new code (52284) was established in the Bladder subsection of the Urinary section to describe cystourethroscopy with mechanical urethral dilation and therapeutic drug delivery via coated balloon. In addition, a new code (58580) was added to the Female Genital System subsection of the Surgery section to report radiofrequency (RF) transcervical fibroid ablation (TFA), including intraoperative guidance and monitoring. Guidelines and parenthetical notes were revised and added to assist with the correct reporting of these services. This article provides an overview of these changes.

Cystourethroscopy With Urethral Therapeutic

With the addition of new code 52284 to the Bladder subsection of the Urinary section, Category III code 0499T, Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed, and its corresponding instructional parenthetical notes were deleted for the CPT 2024 code set.

A cross-reference parenthetical note was added to inform users of the deleted code and that new code 52284 should be reported when cystourethroscopy with mechanical urethral dilation and therapeutic drug delivery via coated balloon is performed.

Description of CPT code 52284

 52281 Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female

(For cystourethroscopy with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, including fluoroscopy,
use 52284)

 52282 Cystourethroscopy, with insertion of permanent urethral stent

(For placement of temporary prostatic urethral stent, use 53855)

 52283 Cystourethroscopy, with steroid injection into stricture

 52284 Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when performed

(Do not report 52284 in conjunction with 51610, 52000, 52281, 52283, 74450, 76000)

Before 2024, cystourethroscopy with mechanical urethral dilation and therapeutic drug delivery via drug-coated balloon catheter was reported with Category III code 0499T, which was added to the CPT code set in 2018. New code 52284 includes both the dilation and delivery of a therapeutic drug and specifically includes the drug-delivery mechanism of using a drug-coated balloon catheter. In addition, the new code descriptor specifies that the procedure is performed on male patients.

A cross-reference parenthetical note following code 52281 was added to direct users to report new code 52284. A parenthetical note following code 52284 was added to prohibit reporting code 52284 in conjunction with codes 51610, 52000, 52281, 52283, 74450, and 76000.

Clinical Example ( CPT code 52284)

A 69-year-old male underwent a transurethral resection of the prostate (TURP) 2 years ago for benign prostatic hyperplasia (BPH). He now presents with worsening frequency, nocturia, and decreased force of stream. An office cystoscopy reveals a dense 2-cm bulbar stricture. To minimize the incidence of recurrence, patient elects to undergo urethral dilation with therapeutic drug delivery by drug-coated balloon catheter.

Description of Procedure ( CPT code 52284)

Position the C-arm with scout films to assure visibility. Using fluoroscopy, inject contrast solution from the urethral meatus to the bladder to identify the length and location of the stricture. After performance of retrograde urethrogram, reposition patient in dorsal lithotomy position. Place appropriate padding at knees and ankles. Prepare and drape patient in dorsal lithotomy position. Prepare and drape the penis. Place the cystoscope per urethra to the level of the stricture and pass a guidewire through the lumen into the bladder.

Use fluoroscopy to confirm appropriate placement. Pass a non-drug–coated balloon over the guidewire to the level of the stricture using fluoroscopic guidance. Inflate the balloon with contrast solution under fluoroscopic guidance to predilate the stricture. Following dilation, deflate the non-drug–coated balloon and remove, leaving the guidewire in place. Place the cystoscope per urethra and position the drug-coated balloon appropriately using fluoroscopic guidance and direct visualization. Inflate the balloon and maintain inflation for a minimum of 5 minutes to allow for drug delivery. Then deflate the balloon and remove, leaving the guidewire in place. Place a 14-French council tip catheter over the guidewire into the bladder with 10 cc of sterile water placed in the balloon.

Radiofrequency Transcervical Fibroid Ablation

Because of the addition of new code 58580 to the Female Genital System subsection of the Surgery section to report RF TFA, guidelines and parenthetical notes were revised and added to assist with the correct reporting of this service. Code 58580 was placed in a new Other Procedures subsection of the Corpus Uteri subsection. As a result of the changes in this subsection, Category III code 0404T, Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency, and its corresponding instructional parenthetical notes were deleted for the CPT 2024 code set. A cross-reference parenthetical note was established to instruct users to report code 58580 when RF TFA is performed. In addition, codes 58353 and 58356 and their accompanying parenthetical notes were relocated from the Corpus Uteri/Introduction subsection to the new Corpus Uteri/Other Procedures subsection.

Description of CPT code 58580

 58353 Endometrial ablation thermal, without hysteroscopic guidance

(For hysteroscopic procedure, use 58563)

 58356 Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed

(Do not report 58356 in conjunction with 58100, 58120, 58340, 76700, 76856)

 58580 Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency

(Do not report 58580 in conjunction with 58561, 58674, 76830, 76940, 76998)

(For laparoscopic radiofrequency ablation of uterine fibroid[s] including intraoperative ultrasound guidance and monitoring, use 58674)

Before 2024, TFA was reported with code 0404T, which was established in 2016, to report the use of RF energy through an ultrasound-guided, incision-free transcervical approach for the treatment of uterine fibroids. This procedure includes an intrauterine ultrasound probe and an RF device combined in a single handpiece. For consistency with the other ablation codes, monitoring was included in the code descriptor of new code 58580.

A parenthetical note following code 58674 was revised with the addition of code 58580, and a new parenthetical note was added directing users to report code 58580 for RF TFA, including intraoperative ultrasound guidance and monitoring.

Reference: CPT assistant February 2024