# Manual Cystolitholapaxy



## KaylaRieken (Jan 21, 2019)

Op Report goes like this:

Cystoscopy was carried out. At this timeframe , the stent exiting the right ureteral orifice had severe encrustation encompassing the entire curl of the distal right ureteral stent. At this timeframe, the short jaw grasper was then used to manually crush and remove the stones from the distal curl. After the this timeframe, the stent was able to be grasped and removed intact. 

Is this ok to charge 52317 even though an instrument wasn't used to generate shockwaves to break up the stones?


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## drewvinson23 (Jan 23, 2019)

Per the definition of CPT 52317:  "Litholapaxy:  crushing or fragmentation of calculus by any means..."

The use of a grasper to manually crush the stone is still considered litholapaxy.

You may also want to look at billing 52318 in this case, as the stones being encrusted on the stent makes it "complicated" for the purpose of coding.

Sincerely,

Drew Vinson
CPC
NW Urology


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