The catheterization, endoscopic procedure, and biopsy would each be reported with separate codes. This is because they are distinct procedures with different purposes, and each one requires specific skills, resources, and equipment. The catheterization (e.g. placement of a catheter through the urethra into the bladder) is necessary to allow access to the ureter, and it requires its own code (e.g. CPT code 51701). The endoscopic procedure (e.g. cystourethroscopy) involves the insertion of a flexible or rigid instrument through the urethra and bladder into the ureter to visualize the area and perform the biopsy. This procedure also requires its own code (e.g. CPT code 52000). The biopsy involves the removal of a tissue sample from the ureter for further examination, and it also requires its own code (e.g. CPT code 52356).
Even if the secondary procedures were somewhat complicated and required additional time and effort, they would still be reported with separate codes. This is because the complexity or difficulty of the procedures does not change their individual nature and purpose. However, the codes may reflect the additional time and effort required, and may have higher relative value units (RVUs) to reflect the increased complexity and resource utilization.