Urology Coding Alert
Add 52 If The Physician Skips Cystourethroscopy
Question: My doctor did a looposcopy with lithotripsy and stone removal. What is the proper coding for this procedure?
Maryland Subscriber
Answer: First, report CPT 52318 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large [over 2.5 cm]) for the lithotripsy and stone removal. Append modifier 52 (Reduced services) because the physician did not perform the cystourethroscopy. Second, report 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the looposcopy performed in place of the cystoscopy.
You should use 52318, a bladder procedure code, because the ileal loop acts as a substitute bladder, and the lithotripsy involves a complicated calculus formed on a foreign body (i.e. the intestinal mucus), which is seen frequently in an ileal diversion.
The diagnosis code you use with 52318 should be bladder calculus (594.1). The diagnosis code for 44380 should be 936 (Foreign body, calculus, in intestine and/or colon). Using these two CPT® codes and specific diagnoses, you should expect payment for both procedures.
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