# 52356



## RainyDaze

I have a question regarding the new code for lithotripsy and stent placement.  Sometimes our docs will perform the lithotripsy and then use a basket to extract the fragments.  The codes 52353 and 52352 use to bundle, so I could only code with 52353.  But now with the new code of 52356, it is not bundling with 52352.  We have a difference of opinion in our office, whether to code with just 52356, or to code with both 52356 and 52352.

Any help is appreciated!

Lori

Here is an example:

POSTOPERATIVE DIAGNOSIS: 7 mm Left distal ureteral stone.

PROCEDURE PERFORMED: Cystoscopy, left ureteroscopy, laser lithotripsy, stone basket, retrograde pyelogram, and 6 x 26 double-J stent placement.

DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative area by name and date of birth. Again, the procedure was reviewed, and he agrees to proceed. Radiologic images were reviewed, and this is a left-sided stone. He received IV antibiotics prior to starting the procedure. He was brought to the operating room, placed in the supine position. He had Venodynes for DVT prophylaxis. Anesthesia was induced. He was then placed in lithotomy and prepped and draped in a general sterile fashion. Cystoscopy was performed, and the left ureteral orifice was identified in its usual anatomic position, and a wire was advanced up to the kidney under fluoroscopic vision. A radiopaque stone was noted in the distal ureter.  Next, a rigid ureteroscope was used, and with the help of a second wire, the ureter was entered. The stone was located. It was lasered into small fragments, which were all basketed and sent for analysis. Next, the mid ureter and distal ureter were inspected, and no fragments were remaining. We performed a retrograde pyelogram for the proximal ureter and upper collecting system, which was unremarkable. We placed a 6 x 26 double-J stent at the end of the procedure, which was left to a string. The bladder was emptied, and all stone fragments were removed and sent for analysis. The patient tolerated the procedure well. There were no complications. He was extubated and taken in stable condition to the recovery room. He will follow up in the office on Monday for stent removal.


----------



## nateich

Here are my thoughts: 52352 and 52353 bundle unless performed on opposite sides.  
I personally would follow the above with 52356; using 52352 or 52353 if performed on the opposite side.

One opinion, any others?


----------



## RainyDaze

That was my thinking too.  I wonder why it is not in the CCI edits though, that is why others in the office are saying we can code both even if it is on the same side.  I wonder if that is a mistake. 

Lori


----------



## rykin7609

I am questioning this also. Been coding Urology for a year and still find myself befuddled at times.

Checked the Edits and nothing. The Ingenix Coder's Desk Reference for Procedures specifically states in all 52352, 52353 and 52356 that stone manipulation and removal occurs BUT, only for 52352 does it state removal by basket. The other two do not mention this. Before I tell my docs that we cannot bill for this, I want to see it in writing that we cannot. However, I do not want to be coding this incorrectly either. 

And just to cover my tracks, I just looked at the wording in the 2013 Desk Reference and unfortunatley it is exactly the same as this years'

Why can this not be made a LOT less confusing???!!!


----------



## rykin7609

Oh, and I forget to mention that if you look at the CPT Guidlines, right under 52356 it clearly states not to bill 52332 and 52353 in conjuction with 52356 when performed on the same side. It absolutely makes no mention of 52352. 

Just a little food for thought


----------



## trinalankford

I'm really glad to see that our office isn't the only one confused by this!

Do any of you have something "official" I can print to show my doc?  This new code 52356 isn't going over well   I printed off the description from FlashCode which pretty much says, "Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)".  Is there anything else out there that might go into a little more detail so that I can show him?

Thank you for your help!


----------



## RainyDaze

I cannot find anything in writing.  I spoke with my manager and she said we should code the 52356 and 52352 even if it was on the same side because there are no bundling issues with these codes.  It doesn't make sense, but we are following the rules.


----------



## rykin7609

The only thing that we can find to stand our ground on is the fact that CCI Edits do not bundle it and the CPT Guidelines do not say, "do not bill 52352 in conjunction with 52356" as it does with the other two codes. 

We are going to bill the 52352 along with the 52356 also. 

May the force be with us...


----------



## nateich

I will contact the AUA Hotline for further clarification. I should get a response in 15 business days.


----------



## trinalankford

I'm going to add a little more confusion to this issue, at least for me.

I just heard back on a claim that was billed earlier this year (DOS 2014, though), before we realized the 52356 even existed.  Our MD does his own coding, and this was billed this as 52353, 52320-51, and 52332-51.  The 52353 paid and the 52332 paid, but the 52320 denied for CCI edit (new edit effective 1/1/2014, apparently).  

HOWEVER, shouldn't the 52353 and 52332 now be combined into 52356??  Since this claim paid, I'm going to have a hard time convincing him that he can't bill 52353+52332.


----------



## RainyDaze

Well, I just received a denial for 52356, stating it is not a recognized code.   I'm not sure if the insurance companies are all on board with this new code yet.  

Yikes,

Lori


----------



## trinalankford

That might explain why my claim went through last week with the OLD codes and not the new one. Interesting.


----------



## OCD_coder

The NCCI edits effective 4/1/2014 are now including the codes discussed above:

52356	52346		20140101	*	1
52356	52351		20140101	*	0
52356	52352		20140401	*	1
52356	52353		20140401	*	1
52356	53000		20140101	*	0
52356	53010		20140101	*	0

52356 probably is going to be a stand alone code for many of our urology surgeries.


----------



## vanessa01

*52356 and 52352*

So 52356 and 52352 are bundled but can be unbundled if done on opposite side- I understand that part but I have a provider that thinks I should unbundle if done on the same side but different areas one in kidney and other in Ureter-
Thoughts?
I am leaning towards only coding 52356 
Thanks


----------

