# 52353 and 52352 together?



## l1ttle_0ne (Dec 9, 2015)

Can you bill for a 52353, and a 52352 together? If they are done at the same time, and on the same side? I'm just wanting to double check. I don't think it should be billed. If you read the operative report he's just removing the stones that he fragmented from the 52353. However it does say you can put a modifier on the 52352. But I think that it would be bundled since it's just the fragments he's removing, and not a separate stone. Any thoughts??  Here is the operative note.

PREOPERATIVE DIAGNOSIS: Left obstructing ureteral stone.
POSTOPERATIVE DIAGNOSIS: Left obstructing ureteral stone.
PROCEDURE PERFORMED: Cystoscopy, retrograde pyelogram, ureteroscopy with laser lithotripsy and stone manipulation, ureteral stent placement -left side. 
FINDINGS: No bladder tumor or stone, minimal ureterectasis and hydronephrosis, stone visible on fluoroscopy at the pelvic inlet, yellow in color stone with evidence of impaction. 
COMPLICATIONS: None.
SPECIMENS: Left ureteral stone.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 5 mL.
BLOOD REPLACEMENT: None.
DRAINS: left 6 French 26 cm Bard Double J Ureteral Stent without string. 
CONDITION: Stable.

INDICATIONS FOR PROCEDURE: This is a year old male. He has a left obstructing ureteral stone causing pain. Risks and benefits of surgery discussed and informed consent obtained. 

DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought to the operating room and placed supine on the table. He underwent general anesthesia. The patient was placed in modified lithotomy position and prepped and draped in sterile fashion. Timeout was held. Preoperative IV antibiotics were confirmed. The cystoscope was inserted per urethra and advanced to the bladder, where cystoscopy was performed. The bilateral ureteral orifices appeared open and patent. There was no evidence of bladder tumor or stone. The left ureteral orifice was cannulated using a 6 French open-ended ureteral catheter, and retrograde pyelogram was performed. There was mild ureterectasis without hydronephrosis. A 0.035 sensor wire was passed to the level of the left kidney. The open-ended ureteral catheter was withdrawn. The scope was broken down and removed. The wire was attached to the drapes as a safety wire. The long semirigid ureteroscope was passed per urethra to the level of the bladder and then into the left ureteral orifice. A stone was encountered near the pelvic inlet consistent with the stone on CT scan. A 365 holmium laser fiber was then passed, holmium laser lithotripsy commenced. The stone was fragmented to less than 2 mm fragments. Larger fragments were grasped and removed using a 2.4 French nitinol tipless basket. The scope was withdrawn. The 21 French panendoscope was reinserted over the wire to the level of the bladder. A 6 French 26 cm Bard double-J ureteral stent without string was passed. Excellent coil formed in the left renal pelvis. The wire was withdrawn and coil formed in the bladder. Stone fragments were evacuated free of the bladder and sent as specimen to pathology. The scope was then withdrawn after the bladder was emptied. Lidocaine jelly was placed per urethra. The patient was returned to supine position, awakened, and transferred to postanesthesia care unit in stable condition.


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## CodingKing (Dec 9, 2015)

No,

See the parenthetical note

(Do not report 52332 in conjunction with 52000, 52353, 52356 when performed together on the same side)


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## JEYCPC (Dec 11, 2015)

Why not use 52356?  It includes lithotripsy, basket and stent.


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## sharmisthade (Aug 1, 2018)

*52353 and 52332 can be billed together as of 2012 guidelines?*



CodingKing said:


> No,
> 
> See the parenthetical note
> 
> (Do not report 52332 in conjunction with 52000, 52353, 52356 when performed together on the same side)



As per 2012 guidelines there is no guidelines for not to bill 52332 with 52353.


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## CodingKing (Aug 1, 2018)

NCCI Manual currently states



> CPT code 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent) describes insertion of a self-retaining indwelling stent during cystourethroscopy with ureteroscopy and/or pyeloscopy and shall not be reported to describe insertion and removal of a temporary ureteral stent during diagnostic or therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy (e.g., CPT codes 52320-52330, 52334-52355). The insertion and removal of a temporary ureteral catheter (stent) during these procedures is not separately reportable and shall not be reported with CPT codes 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service or 52007 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis).


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## drewvinson23 (Aug 2, 2018)

In this instance, it would not be correct to bill both 52353 and 52352.  From the operative note provided here, it appears that this is 52356 (lithotripsy with insertion of an indwelling ureteral stent).  The provider breaks up the stone with lithotripsy, and then uses the basket to remove those pieces and places an indwelling ureteral stent.  If the basket removal is of pieces of the stone that he just broke up, then you cannot bill for the basket removal.

Our office follows AUA coding guidelines.  Per their recommendation, you can bill a 52353 and a 52352 on the same side, if done in separate structures to separate stones.  For example, the provider does lithotripsy and basket removal of pieces of the stone in the kidney, and then also removes a separate stone in the ureter.  In this instance, per the AUA recommendation, you could bill 52353 (with the Dx code of N20.0) for the lithotripsy of the stone in the kidney, and then 52352 with a 59 or XS modifier (with a Dx code of N20.1) for the removal of a stone in the ureter.  The pivot of coding here is that the stones have to be separate, non-contiguous stones in separate structures.

However, our office has started to see some denials from billing multiple stones on the same side with certain insurance companies.  It is our belief that some insurances follow the parenthetical note found in the CPT manual to not bill these codes on the same side.  You would have to inquire with your specific payer in regards to their policy and/or edit.

Here is a good article on the AUA's stance on billing for multiple stones.  I hope you will find it useful.

http://www.urologypracticetoday.com/billing-for-multiple-stones/

Drew Vinson
CPC
NW Urology


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