Urology Coding Alert

Question: The urologist performed ESWL for a kidney stone and ureteroscopic fragmentation of an ipsilateral ureteral stone. What procedure and diagnosis codes should I file?

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Answer: For ESWL of the kidney stone, report 50590 (Lithotripsy, extracorporeal shock wave) with diagnosis N20.0 (Calculus of kidney). Then code the ureteral stone fragmentation as 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) with modifier XU (Unusual non-overlapping service) and diagnosis N20.1 (Calculus of ureter).

Remember: Modifier XU was one of several new modifiers introduced in 2015 as more specific options than the standby option, modifier 59 (Distinct procedural service). Modifier XU comes in handy when you want to report a service that is distinct because it does not overlap with the usual components of the main service. In this case, the surgeon used different equipment and operating techniques to treat the two stones.