# Cysto/ureteroscop/eswl



## nabernhardt (Dec 13, 2011)

patient had cystoscopy and ureteroscopy and then did a ESWL.  Would I be able to do both the 52351 and 50590 where the scope was removed and then the lithotripsy was done. Or is the 52351 bundled in?  

PROCEDURE: The patient was anesthetized with general anesthesia and repositioned in
lithotomy using Allen stirrups. Her perineum was prepped and draped in a sterile manner. A Storz 22 French cystoscope was inserted and the bladder was inspected and was unremarkable. I did not see any evidence of stone at the right orifice. The scope was changed to the Storz mini ureteroscope which was advanced up the right ureter without difficulty and I did not need to use a wire. No stones were seen at all in the distal ureter. The scope was removed. The patient was repositioned. Using 2-dimensional fluoroscopy, the right renal stones were centered and the therapy head was then raised and final centering was achieved. The treatment was begun at 16 KV and the KV was slowly increased to a maximum of 24. A total of 3,000 shocks were delivered and
the three different stones appeared to fragment adequately on fluoroscopy. The patient tolerated
the procedure well and there were no complications.


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## rsmith1 (Dec 15, 2011)

It is bundled but per CCI, you can break the bundle with the 59 modifier.


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## nabernhardt (Dec 15, 2011)

thank you.  Which I did read that. But I don't know whether this qualifies to use the modifier 59 or not?  Any opinions please. How do I make the decision of determining whether it is distinct or not?


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## Kelly_Mayumi (Dec 17, 2011)

It sounds to me like the doctor was checking to see if there were stones in the ureter that were going to need to treated at the same time as the renal stones.  I would not -59 the 52351.  Just my opinion.


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## nabernhardt (Dec 17, 2011)

I think that is what I am leaning more towards too.  Its just hard sometimes to decide whether it counts as distinct or bundled.  Thanks for your advice.


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