Urology Coding Alert

There are codes for inserting a stent 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) and for removing a stent 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) or 52315 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; complicated). But what if you have a patient who requires frequent, regular stent changes on a monthly basis? Many commercial carriers pay only for 52332 but not for the removal. But by using the correct modifier, urologists can ensure they will receive proper reimbursement for both procedures.

Most of the time we bill both codes with no problem, says Donna Cardarelli, biller for Urology Associates, a four-urologist practice in Haverhill, Mass. CPT code 52332 should be on the first line of the HCFA 1500 claim form, and 52310 (or 52315) should be on the second, along with modifier -51 (multiple procedures). If the stent is encrusted, it would definitely be a 52315, says Haverhill. If it is a routine stent change, it would be 52310. But definitely, if you remove one stent and insert another, you should be reimbursed for both procedures, Cardarelli stresses.

Michael Ferragamo, MD, a urologist who practices in Hempstead, N.Y., agrees. For obtaining reimbursement from commercial carriers, use 52232 as the first procedure, and 52310 with modifier -51 appended on the second, he says. Further, if you perform bilateral stent changes, you should put modifier -50 (bilateral procedures) on the first line. There is no global period on either of these codes, so you can use them as often as you want, he says.

Tip: If the stent change is done within the global period of a surgical procedure, you would have to use modifier -58 (staged or related procedure or service by the same physician during the postoperative period) on both 52310 and 52232.

Coding for a Separate Procedure

Medicare definitely allows both codes to be billed. But with commercial payers, the situation may be different.

CPT provides that 52310 is commonly carried out as an integral component of a total service or procedure. Any code that is designated as a separate procedure should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. An argument certainly could be made that removal is an integral part of insertion at some point, the stent must come out. But commercial payers may argue that the work value for the removal is included in the fee for the insertion.

According to CPT, when a procedure that is designated a separate procedure is performed independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/ services by appending the modifier -59 (distinct procedural service) to the specific separate procedure code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure.

Some commercial payers may not pay for 52310 and 52332 at the same session. But, as CPT defines the use of modifier -59 on a separate procedure, the examples include a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries). Stent removal is clearly a different procedure from stent insertion.

Code 52332s descriptor refers only to insertion. With no mention of removal, there is the implication that 52332 is only for insertion, notes Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding, reimbursement and compliance consultant based in Denver, Colo. So a lot of people view the separate procedure indicator on 52310 as a misnomer, she says. If I filed both codes with a commercial payer and received a denial, I would try appealing it.

Note: When doing stent changes, you should use the diagnosis code for the condition that necessitates the stent, says Page.