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Urology Coding Alert

Reader Question:

Reader Question:

Published on Sat Sep 01, 2001

Question: Sometimes a stone is in the ureter, and the urologist performs a lithotripsy to break it up. Is this coded the same way as a stone in the kidney? What if the urologist has to move the stone back into the kidney?

Georgia Subscriber
 
Answer: It depends on what kind of lithotripsy was performed. If the physician fragments the stone with a lithotripter that is inserted into the ureter, with the stone still in the ureter, use 52353 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]). The urologist views the stone ureteroscopically.
 
Sometimes the urologist first manipulates the stone out of the ureter back into the kidney and plans to perform extracorporeal shock wave lithotripsy (ESWL) to fragment the stone at a later date. For the first procedure, in which the stone is moved into the kidney, use 52330 (cystourethroscopy [including ureteral catheterization]; with manipulation, without removal of ureteral calculus). The physician then may perform the ESWL to fragment the stone: Use 50590 (lithotripsy, extracorporeal shock wave).
 
When performing the cystourethroscopy (52330), the urologist manipulates the stone under fluoroscopic visualization (76000, fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), using the stone basket or the catheter to manipulate, but not using a scope. Some urologists also use fluoroscopy when performing the manipulation and internal lithotripsy under ureteroscopic visualization, 52353.
 
Do not append modifier -26 (professional component) to 76000 for Medicare because the fee schedule now mandates that the professional/technical component no longer applies. (For more on this subject, see the August 2001 issue of Urology Coding Alert, News Briefs: Code 76000 Needs No Professional Modifier.)
 
Not all carriers will pay for fluoroscopy (which pays about $8) in addition to ureteroscopy. They reason either  that fluoroscopy is an integral part of the ureteroscopic procedure or that you dont need two methods of visualization. Under CPT rules, if you use fluoroscopy, youre entitled to bill for it, and you dont need a separate reason to do so. However, payers may not agree with CPT.
 
The final code would be the ureteral stent insertion. Use 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) with modifier -51 (multiple procedures) appended.
 
Code 52332 is bundled into 52330, so modifier -59 (distinct procedural service) is required. The claim for the total sequence of procedures -- stone manipulation at the first session and ESWL and stent insertion at the second -- would be as follows:
 
Session 1: 52330
 
Session 2: 50590 (line 1), 52332-51 (line 2).

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