Urology Coding Alert

Stent insertion 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) presents many coding quandaries because it usually is done in relation to other procedures, and it is unclear whether you can bill separately for the stent. Since 52332 is proposed to be increased by $450 over the next two years (see Code 52332 to Increase By $450 on page 60 in the August 2000 Urology Coding Alert), its going to be especially important for urologists to know how to bill it correctly.

If you put in a temporary ureteral catheter or attach to a Foley, you cant bill for the stent, says Jules Geltzeiler, MD, who practices with Shore Urology in Long Branch, N.J. But if it is a permanent stent, you can bill separately.

For example, if a urologist removes a stone from the ureter and bills using 52336 (cystourethroscopy, with ureteroscopy and/or pyeloscopy [includes dilation of the ureter and/or pyeloureteral junction by any method]; with removal or manipulation of calculus [ureteral catheterization is included]), you also can bill for 52332, but you must append modifier -59 (distinct procedural service) to the 52332.

In fact, Geltzeiler says it is possible for urologists to get paid for a stent even if they are putting it in for the same reason they are performing the other procedure, such as the ureteral stone removal (52336). Thats because when Medicare figured out the work value for a stone removal, it did not include the work value for a stent, says Geltzeiler.

Carol Hutson, office manager with Germantown Urology Center of Germantown, Md., recommends that coders always check with their Medicare carriers before determining how to bill a permanent stent insertion, as well as billing for other procedures. I always refer back to Medicare, she says. I have a list of documentation checks, including whom I have talked to there. But after double-checking with her carrier, she says that in general, Medicare will pay separately for the stent with a modifier -59.

Separate Diagnosis Unnecessary

Some urology coders think that you need to have a separate diagnosis to get paid for the stent insertion, but you dont. CPT has determined that the insertion of an indwelling stent is a distinct procedure and should be charged separately even if for a related reason, says Ray Painter, MD, president of PRS, a coding, compliance and reimbursement consulting firm based in Denver. Medicare should not require a separate diagnosis, says Painter, a urologist.

But if the stent needed to be inserted because two days after the ureteral [...]