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Urology Coding Alert

Get Paid for Stent Placement and Removal in Same Session

Published on Wed Aug 01, 2001

When a urologist changes a ureteral stent, the question is whether he or she should bill for the placement of the new one only, or for the placement of the new and the removal of the old. There is no single code for stent "exchange," but there is a code for "removal" and another code for "placement."
 
Some carriers bundle the removal and placement codes, while some pay for both at the same session. Ask  your local carrier for its policy.  
 
Medicare allows payment for both. For Medicare patients, bill 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) for stent placement and 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) for stent removal with modifier -51 (multiple procedures).  
 
The Correct Coding Initiative (CCI edits) do not bundle 52310 into 52332, but your carrier may not be aware of that CCI preference. If your carrier allows it, bill 52332 and 52310-59-51 for the stent exchange.
 
"These two codes aren't bundled, but because 52310 has a separate-procedures indicator, use modifier -59 (distinct procedural service) to be on the safe side," says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a Denver-based coding consultancy. Modifier -59 requires that you document a separate and distinct reason for the removal. "You can't just say, 'Replaced a stent without difficulty,' " Page says. The urologist must document the reason for the removal. For example, removal of a nonfunctioning obstructed stent would justify billing as a separate procedure.
 
Another way to bill for a stent removal and insertion at the same session is to append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) to the removal code, says Laura Siniscalchi, RHIA, CPC, CCS-P, senior consultant at Deloitte and Touche, an auditing firm in Boston. When you place the first stent, indicate clearly in your notes that you may have to replace it later. This is the method preferred by CPT, she says.
 
"The first time you get an explanation of benefits and the 52310 is denied, send it in again with a -59 modifier. If that is paid, then you know how they want you to file it," Page says.
 
Because the code for placement does not include the value for removal, you should be able to bill and be paid for both. Neither Medicare nor CPT bundles the two codes together. But even if you use modifier -58 or -59, the payer may decide not to pay for the removal, Siniscalchi says.
 
"On a Medicare patient, we bill the removal with modifier -51," says Morgan Hause, CCS, CCS-P, coding compliance specialist with Urology of Indiana, a 17-provider practice based in Indianapolis. "On others, we use modifier -59."

Coding for the Postoperative Period
 
Stent removals are often done within the postoperative period of a stone treatment procedure. Code stent removal after ESWL (50590) or percutaneous nephrostolithotomy (50081) within the 90-day global with modifier -58. Stent removal following a ureteroscopic procedure will not require a modifier because all ureteroscopic procedures have a zero-day global period.
 
Sometimes, the urologist changes a stent during a second procedure. For example, the patient undergoes a lithotripsy, 52353 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]). The urologist documents that a repeat lithotripsy will be necessary in a few weeks. The physician inserts a new stent at the second lithotripsy. Bill 52353-58 for the second lithotripsy, and 52332-58 for the second stent insertion. In this case, you cannot bill for the stent removal (52310) because it must be done as a separate procedure. CCI bundles the removal into the primary procedure.

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