# Rt ureteroscopy, laser lithotripsy, stone extraction Ureteral stone and Rt ureteroscopy laser lithotripsy, stone extraction of renal stones. placemen



## carol52 (Feb 16, 2021)

Hello, I am confused about the laser litho with stone basket remove both ureter and kidney RT side only.
 A semi-rigid ureteroscopy was advanced in the ureter.  A large amount of stone was encountered in the distal 1/3rd of the ureter.
The stones were fragmented using laser and the fragment were removed with a basket.

With a safety wire in place , a flexible ureteroscope was passed over a working wire through the rt urinary tract into the rt renal pelvis. Flexible ureteroscopy and pyeloscopy was then performed .. The stone fragments ere seen and lasered .. All fragments amenable to basketing were removed. 
a stent was also placed.
 Dr. are wanting to bill 
52356 and 52352 XS 
is this correct.
I did not think you could bill the basket with the removal of stone fragments.


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## thomas7331 (Feb 16, 2021)

You are correct, per the NCCI guidelines you can only bill the bundled code when performed on the contralateral side.  The XS modifier is not supported here since both procedures were on the right side.


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## carol52 (Feb 16, 2021)

This was what was sent to me from a manager where I work the  last line listed below was from the Dr.  the op note at the top is Verbatim

CPT 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [eg, Gibbons or double-J type]) includes the following parenthetical in the CPT code book: “(Do not report 52356 in conjunction with 52332, 52353 when performed together on the same side).” From a CPT perspective, due to this parenthetical, it makes no difference if you treat a stone in the ureter and stone in the kidney with lithotripsy because CPT 52356 is the only code that can be reported for the lithotripsies performed.



Keep in mind, when going up the ureter into the kidney, if you run into a stone, you must address it first, sometimes that may be by lithotripsy then basket extraction and then the same procedure would be done in the kidney. This is a more involved scenario, as you can’t reach one without first clearing the other.

_also noted that the there is a second stone in the kidney requiring basket extraction. As this stone is in a separate structure than the ureteral stone and treated with a different modality, we would code this with 52356 and 52352-XS._


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## thomas7331 (Feb 16, 2021)

I understand what they are arguing but I disagree.  I would refer them to Chapter VII of the NCCI manual, section H, paragraph 3, which clearly states that the unit of service for the treatment of a stone is one per side - not per calculus or per treatment or per location within the side - see below.  I think the NCCI is quite clear that these codes are valued to include the work of both the lithotripsy and the removal of the calculus and you may never report two treatments on the same side.  It would be inappropriate use of the modifier to bypass the bundling in this situation.

_The UOS for a procedure describing destruction or removal of renal system calculus(i) is one. The unit of service is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, the CPT code may be reported with modifier 50 and one unit of service.

For example, CPT code 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)) shall be reported with only one UOS per ureter regardless of the number of calculi in the ureter. If the procedure is performed on bilateral ureters, it may be reported with modifier 50 and one unit of service. This code shall not be reported with a separate unit of service for each calculus._


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## carol52 (Feb 16, 2021)

I feel like I am caught in the middle... this Dr. treats my daughter for stones know who I am   I feel targeted.
Don't know where to turn for this.....


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## thomas7331 (Feb 16, 2021)

carol52 said:


> I feel like I am caught in the middle... this Dr. treats my daughter for stones know who I am   I feel targeted.
> Don't know where to turn for this.....


Sorry to hear - I know that's an uncomfortable and difficult situation to be in.  But it would be unethical for a physician or manager to retaliate in any way for your raising this question.  I would perhaps consider asking your payer to mediate.  Feel free to send me a private message if it's something you'd like to discuss outside the forum.


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## carol52 (Feb 16, 2021)

Thank you for your help !!!


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## carol52 (Feb 17, 2021)

carol52 said:


> Thomas how do I get back to our last thread  I closed and don't remember where to go to bring up your response about the AMA and Urology Society.


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