Urology Coding Alert

Good news: You only have a few edits to add to your bundling lists. 

The second round of Correct Coding Initiative (CCI) edits for 2014 does some cleanup, bundling new 2014 codes with existing codes. The urology code in the crosshairs is 52356 (Cystourethroscopy with ureteroscopy and /or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent eg. Gibbons or double-J type).

“Overall, it’s a bit of a yawn this time, which is probably good,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. “There are 4,322 new edit pairs, bringing the total active list to 1,314,537 active pairs.”

Take a look at what you need to know to avoid claims rejections when you use this new code along with other urological procedure codes. 

Skip Ureteroscopic Stone + Lithotripsy Coding 

CCI 20.1 bundles the new 2014 code 52356 with column 1 codes 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50081 (... over 2 cm). 

This bundling edit has a modifier indicator of “1.” That means “the bundling can be undone under specific circumstances with a modifier — most often modifier 59 (Distinct procedural service) — and both CPT® codes may then be billed and likely paid,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. 

You may use modifier 59 to override this bundling if the urologist is unable to break up the stone endoscopically and he must then perform the ureteroscopic procedure, says Christy Shanley, CPC, CUC, billing manager for the University of California, Irvine. 

“Bill 50080 or 50081and 52356 during this same encounter when both procedures are utilized to completely remove the stone,” Ferragamo agrees. “Although this would be an infrequent and unusual clinical scenario, both procedures may be required, and hence the use of modifier 59 on CPT® code 52356 to also ensure payment for this latter procedure.”

52356/52352 Bundles Reflect Previous Edits

You’ll also find that CCI 20.1 creates bundlings between 52356 and the following column 2 codes:

• 50561 — Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 50961 — Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 50980 — Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
• 52320 — Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus
• 52330 — ... with manipulation, without removal of ureteral calculus
• 52352 — Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
• 52353 — ... with lithotripsy (ureteral catheterization is included).

These edits also have a modifier indicator of “1,” allowing unbundling of these pairings under certain clinical circumstances. For example, you may use modifier 59 to break the bundle between 52356 and 52352 or 52353 if your urologist performs the 52356 procedure on the patient’s right side and the 52352/52353 procedure on the left side, Shanley says. 

Additionally: “CPT® code 52352-59-76 (Repeat procedure or service by same physician or other qualified health care professional) may also be billed with 52356 when a calyceal stone has also been removed at the same encounter from the same kidney when a renal pelvic stone has also been fragmented and a JJ stent placed (52356),” Ferragamo adds.

Pointer: “The bundling of 52352 with 52356 resumes the previous similar bundling of the two codes 52353 and 52352, when 52352 should not be billed with 52353 when treating the same kidney stone,” Ferragamo points out.