Code by Type of Stone Removal To Ensure Correct Payment
Published on Sat Sep 01, 2001
When a patient has more than one stone in one kidney (multiple stones), or stones in both kidneys or ureters (bilateral stones), the urologist can gain more reimbursement and avoid fraud by coding based on the type of removal performed.
Different types of stone removals are outlined below with the correct coding solutions.
Removal by Lithotripsy
Code removal by extracorporeal shock wave lithotripsy (ESWL) with 50590 (lithotripsy, extracorporeal shock wave). The urologist can often ethically gain more reimbursement for treating multiple and/or bilateral stones.
Multiple Stones. The urologist performs ESWL to break up a kidney stone. But neither the technique nor the code allows the urologist to target just one stone, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver. The ESWL procedure is the same regardless of the number of stones in the kidney, so there is no justification for billing extra for multiple stones. Whether the stones are in the renal pelvis, the calyx, the ureteropelvic junction, the ureter, or all four locations, use 50590 only once per kidney. The code is valued at a high rate because it is intended to cover those occasions when multiple stones are treated as well.
Staged Treatment. Most urologists would treat bilateral stones with ESWL at different times one within the global period of the first " says Michael A. Ferragamo MD assistant clinical professor of urology at the State University of New York at Stonybrook. "So they would need to indicate in the preoperative note that the ESWL will be staged with one kidney initially and another several weeks later." Append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) to the second 50590 if done at a different time.
Note: When a patient has stones in both kidneys some urologists may treat both with ESWL at the same time although this is unlikely. Report 50590 with modifier -50 (bilateral procedure) in this case.
Use -LT and -RT modifiers to indicate on which kidney the 50590 is per-formed. If the left kidney stone is treated first use 50590-LT; for the second ESWL use 50590-RT-58.
Sometimes stones are treated more than once. For example the left kidney is treated in July and again in August and the right is treated in September. CPT Code 50590-LT for July 50590-LT-58 for August and 50590-RT-58 for September.
Removal by Ureteroscopy
Removal by ureteroscopy is coded 52320 52325 52330 52352 or 52353. Only ureteroscopy codes 52353 (cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) and 52354 (... with biopsy and/or fulgration of lesion) can be billed bilaterally says Cynthia Jackson RRA CPC coding specialist for Emory University Urology Group in Atlanta. "It is appropriate to bill these [...]
