# dif of opinion 52310 vs 52353



## MLWILLINGHAM (Feb 11, 2014)

*HELP !*My urologist chose 52310 -
my thought is 52353 - here is an excerpt of the note ...

_"...patient prepped and draped in lithotomy position on the lithotriptor table.  A 22 French cystoscope was inserted into the bladder and the trigone was visualized to be within normal limits.  A 0.035 glidewire was inserted into the left ureteral orifiece and in a retrograde fashion under fluoroscopy was brought up past the calculus which was in the area of the left ureteropelvic junction.  Once this was completed, we passed a 6-French x 24-cm double-J setnt , which easily passed the calculus and actually manipulated it back into the kidney.  Once the stent was in good position, the scope was removed.  The patient was taken out of lithotomy position and placed on the lithotriptor table so that the calculus could be targeted in both an AP as well as 30-degree oblique plane.  With the calculus targeted, we began lithotripsy at a power level of 3 at 120 pulses per minute.  We continued at the same rate and increased the power up to a level of 8 with good fragmentation of the calculus. ... The patient tolerated the procedure well after a total of 2500 shocks and returned to the recovery room in good condition."_

Any response is welcome


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## OCD_coder (Feb 11, 2014)

Actually, a lithotripsy with a double-J stent placement is 52356.  (RVU 8.0)  You were super close and your surgeon is going to be tickled pink when he/she discovers why you are so important to their AR with your coding skills.  Good Job!

52310 is just removal of the calculus *or* the stent, without stent placement and without lithotripsy. (RVU 2.81)
52353 is *without* the placement of the Double-J stent. (RVU 7.5)

http://www.auanet.org/advnews/hpbrief/view.cfm?i=2678&a=5355


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## MLWILLINGHAM (Feb 12, 2014)

Thank you so much, for your help.  That code is it !


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## nateich (Feb 13, 2014)

This sounds like a stent was placed to protect the ureter during a ESWL; not a cysto with lithotripsy and stent placement.

If I am reading your scenario correctly, codes would be 50590, 52332.

Check with your physician for clarification. Let us know.


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## trinalankford (Feb 13, 2014)

I agree with Natalie.  In a nutshell, 52353 is actually done with a laser from inside the body, and 50590 is done from outside the body (with the lithotripter machine), as you documented here:

_"Once the stent was in good position, the scope was removed. The patient was taken out of lithotomy position and placed on the lithotriptor table so that the calculus could be targeted in both an AP as well as 30-degree oblique plane."_

50590 and 52332.

I, too, would be curious what your doc has to say.


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## OCD_coder (Feb 13, 2014)

I have reviewed the information by both additional comments and while I respect their opinions and thought process....

I disagree with billing two different CPT codes for the work described in the original post.  After consideration and discussion with other GU specialty coders I consulted, the 52356 us still the correct code to use as it describes the work performed in its entirety.  The lay description of the 52356 includes the use of  "An ultrasonic, electrohydraulic, or laser technique is used" as part of the code and it is incorrect coding to "fracture" the procedures into multiple components when a more comprehensive CPT code is available.


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## nateich (Feb 13, 2014)

This is a great discussion...I hope we all can learn something here.

"In extracorporeal shock wave lithotripsy (ESWL), the kidney stones are broken up from outside the body with the use of a targeted shock or sound wave the patient is placed on a lithotripter table."

"Laser lithotripsy requires the insertion of a device (cystourethroscope) into the ureter for the purpose of aiming at and breaking up the kidney stones."

Lithotomy position = child birth position

Hmmm...with the scope removed and patient out of the lithotomy position how was the procedure performed? 

Again, ask your physician or the nurse for clarification. You could potentially by leaving big BIG money on the table by not coding an ESWL, if that in fact is the correct procedure. It could also be fraudulent to not code to the most accurate code.

I am respectfully sticking to my guns on this one: 50590 and 52332

Please keep us posted Melonie.


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## MLWILLINGHAM (Feb 20, 2014)

MLWILLINGHAM said:


> Thank you so much, for your help.  That code is it !



PROBLEM - the surgery was performed in 2013, and code 52356 was not effective until 01/01/2014.

So I still need help.


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## nateich (Feb 20, 2014)

_If_ the lithotripsy was preformed thru the scope you would use 52353 LT and the stent placement 52332 LT.

Curious minds want to know, have you asked for clarification? ESWL vs Scope?


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## OCD_coder (Feb 20, 2014)

Prior to 2014 the two code combination is the correct codes.

But effective 1/1/2014, the 50590 was bundled into the 52356 and cannot be billed for the same date of service with a modifier 59.


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## nateich (Feb 20, 2014)

To use both codes (in 2013) 50590 and 52353-59, the physician would have had to used the lithotripter (laser) internally thru scope and also performed an ESWL-extracorporeal shock wave lithotripsy.

SuperCoder shows that both codes (in 2014) 50590 and 52356-59 (this code combines 52353 and 52332) can be billed together.

In the scenario initially presented, I still believe an ESWL was performed after the stent placement.  50590 and 52332


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## MLWILLINGHAM (Feb 21, 2014)

*Thank you*

Thank you all for your help, and Natalie I will be meeting with the physician next week and will ask for a clarification.


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## trinalankford (Mar 11, 2014)

Did you ever happen to meet with the physician?  I'm very curious to find out what happened.


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## RainyDaze (Mar 13, 2014)

To me this looks like an ESWL with a stent placement.  Lithotripsy was performed outside of the body.  I would use 50590 and 52332.


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