# 52353 & 52356



## MACACERES (Aug 26, 2014)

*Urology - 52353 & 52356*

Hi Everyone,

I am stuck on whether or not I can bill for more than one lithotripsy, 52353,  when the provider is stating that he removed more than one stone by lithotripsy from a different part of the kidney, same side.  Also on whether or not I can bill for 52352 with that/those codes?  Example of OP note:

The bladder was entered.  The left ureteral stent was visualized.  This was subsequently pulled back to the meatus, and the wire was then used to cannulate the stent up into the kidney.  At this time the stent was removed, sent to pathology, and subsequently using a semi-rigid ureteroscope the ureter was now cannulated.  Stones were visualized, and at this time using the 360 nanometer fiber the stones were subsequently broken into multiple small pieces, and the ureter was cleared.  At this time, then, some stones did appear to go back up into the kidney, and a decision was now made to go into the kidney and chase these stones.  At this time, then, a second wire was placed up, and then a ureteral access sheath was placed over the wire, and a safety wire was left in place.  The flexible ureteroscope was now placed up the ureteral access sheath, and at this point there did appear to be 2 clustered stones, 1 in the lower pole and 1 in the midpole.  Subsequently, stones were brought from the lower pole up to the midpole stones, and then using a 365 nanometer laser fiber these stones were subsequently broken into much smaller pieces.  Some of these pieces were also removed, as well.  At this time visibility became poor, and a decision was made to stop, and over the safety wire subsequently a 7-French double-J stent was now placed up.  A good curl was seen in the bladder, and one was seen in the kidney.  There was minimal blood loss.  Specimens removed were ureteral stones/renal stones and an old double-J stent.  There were no complications, and a 7-French new double-J stent was put in place.


My thoughts were:

52356
52353-59
52352-51
??


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## nateich (Aug 27, 2014)

I personally would code 52356 LT only.

The stones that were in the ureter are broken up and then some moved into the kidney.

Any other opinions?


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## MACACERES (Aug 27, 2014)

Thank you Natalie!  That is what I was thinking but I googled some info, and some websites seem to think it would be okay to bill...


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