# One stone, two forms of fragmentation



## JenLawson (Jul 18, 2014)

Hi all,
I have a situation in which the surgeon started with lithotripsy using holmium laser to fragment a stone that was impacted in the proximal ureter. Once the laser was engaged the stone move into the kidney. At this point the surgeon disengaged the laser, place a stent, and removed the scope. He then switched to ESWL to complete the stone fragmentation.
He coded 50590 and 52356 to account for both methods of fragmentation used. 

My question is: Can I code for both methods of fragmentation, or should I use only the code for the one that successfully fragmented the stone? 
I would appreciate any resources documenting how this situation should be handled, if possible.

Thanks,
Jennifer


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## kvangoor (Jul 21, 2014)

No, you cannot bill for both. There is a CCI edit that bundles both of these services on the same day for the same patient. Most payers will only consider payment on the 50590.


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## JenLawson (Jul 24, 2014)

Thanks! I was thinking that was likely the case, just wanted to be sure.


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## nomie7 (Jul 25, 2014)

I have this same situation. Thoughts on also billing 52332 in addition to 50590?


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