# Cystolitholapaxy question



## LTibbetts

I have a very brief op note description for 

1. Cystolitholapaxy
2. Placement of right double-J ureteral stent
3. Shockwave lithotripsy to right renal calculi

Cystourethroscopy was notable for finding several small stones within the bladder and these were broken up and manually removed using a manual grasper. We did this until the bladder was free of stones. Over a guidewire, a double-J uretal stent was inserted into right kidney. The patient was then repositioned on the medispec EM1000 lithotripter so the two right renal stones were sequencially placed at the F2 focal point. We delivered 4200 shocks to two areas of stone. Intermittent flouroscopy was utilized to ensure the areas of stone were maintained at the F2 focal point. The stones then suggested some comminution and the patient was transferred to recovery.
The codes I have so far are 50590 and 52332. I want to add the 53217 for the manual break up of the stones in the beginning. Is that correct or am I way off?
Leslie, CPC


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## magnolia1

Your code choices are good, but I think you mean "52317", not 53217.


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## LTibbetts

Yes, I did...thank you So you would use all three codes also?


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## EHollingshead

Your right in your codes with the 52317.

50590   592.0
52317-51   594.1
52332-51   592.0 

Are you billing the PC for the fluro?  Some pay, some don't.  You don't bill Medicare and Medicaid.  

Liz, CPC, CMC, CMSCS


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## rmiller2012

I would bill like Liz did but would include 
50590-RT 
52317-RT-51
52332-RT-51
76000-26 (if you doc performed the test only)


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## Kelly_Mayumi

*bundling?*

Please remember to check your bundling before you submit the code selection.  I cannot recall, but I thought 52332 and 52317 were bundled, but like I said, I cannot recall off the top of my head.


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## LTibbetts

*bundling*

Thanks all! I will check the CCI for that issue. And I did code for the flouroscopy


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