Anesthesia Coding Alert

Question: A patient underwent a cystourethroscopy (52332, cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) and after the procedure was transferred to another facility for lithotripsy (50590, lithotripsy, extracorporeal shock wave). Which code do we use, and how do we bill time for both procedures?

Nevada Subscriber

Answer: If the patient remained asleep and the anesthesiologist was absent between the procedures, bill only one code (the one with the highest base units, in this case, the lithotripsy) with discontinuous time. If the patient was awakened, the cystourethroscopy was completed, and then the patient was returned to the operating room for lithotripsy, bill it as two separate cases with modifier -59 (distinct procedural service) attached.