# Cystoscopy Coding



## KANDREWS131 (May 10, 2017)

I need some help coding a procedure. The doctor performed a cystoscopy, right retrograde ureteropyelogram, right ureteroscopy, laser lithotripsy, and removal and replacement of right ureteral stent. I'm new to coding for general surgery/urology so I'm not sure where to start and what can be billed here. I have CPT code 52353, and I believe I won't  be able to bill for the removal and replacement of the stent. The pyelogram--can I bill 74420-26? I'm mostly unsure about that part. Any help would be appreciated! 
 Here is a description of the procedure: 
External genitalia seemed unremarkable.  Normal saline solution utilized as well as the 21-French scope, 30-degree lens for sterile cystoscopy.  The anterior urethra endoscopically opened unremarkable.  Membranous urethra normal.  BPH noted within the bladder, yellow urine drained, sent for culture.  The bladder contour stable with no signs of bleeding, tumor or stones.  Left ureteral orifice unremarkable.  Right ureteral orifice with stone in place, no encrustation or clot.  Fluoroscopy notes no stones along the stent, and the right stone in the kidney.  With graspers, the stent was removed outside the patient and a 0.038 sensor wire was fed through the stent up to the kidney.  The stent was removed intact and discarded per routine.  With the wire in place now, over the wire, and under fluoroscopy, a flexible ureteroscope was passed over the wire up to the kidney without difficulty.  The wire was removed.  I felt it would be better to not have the safety wire because then I would have more room for post-irrigation and allow for visualization intraoperatively.  Inspection of the calix renal pelvis infundibulum notes some mild erythema, edema in bladder neck and the renal pelvis where a stone had been located.  There was a single stone and I was able to manipulate post-laterally to the calix and it spiculated yellow radiopaque.  Too large to basket.  With the 200 holmium laser micron fiber, standard setting, 0.8 power, rate of 7, holmium laser lithotripsy undertaken of the stone.  The stone was whittled down over time into dust and small passible pieces.  There was a lot of this stone fragment to pass since it was a large stone, but I believe endoscopically everything has been treated to a passable size.  Thus, the wire was replaced and the scope removed intact and there was no complication with lasering and the laser fiber had been removed intact.  With a 5-French open-ended catheter through the cystoscope, the wire was back-fed on the cystoscope, placed intravesically, the open-ended catheter advanced proximally, wire removed, contrast injected for ureteral pyelogram to define the anatomy.  No intraluminal defect, no extravasation, no further identified stone.  The appropriate ureteral length was measured, the wire was replaced, open-ended catheter removed and under direct vision aid of fluoroscopy, a right 6-French 24 cm length ureteral stent, Polaris Ultra, was placed on the right.  The wire was removed.  There was a nice curl in the right renal pelvis, confirmed on fluoroscopy, and a nice curl within the bladder, drained rapidly, cleared to tinged red urine.  No active bleeding.  The bladder was decompressed and the scope removed from the patient.  The right ureteral stent remained.  Lidocaine Uro-Jet placed intraurethrally.


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## Machelle Freeman (May 10, 2017)

I am coming up with 52356...that includes the laser and the stent removal/replacement.

Machelle Freeman, CPC


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