Urology Coding Alert
Check Whether Modifier 22 Might Apply to Extensive Case
Question: The urologist placed the ureteroscope to visualize the patient's stone. She saw the stone, but it was encased in scar-impacted material. She used a laser to incise the scar and expose the stone. She then used the laser to fragment the stone. The remaining stone material was basketed and she placed a JJ stent. What is the correct procedure code for all these actions? Wisconsin Subscriber Answer: The most appropriate procedure code is 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Since there is no CPT® code for the ureteroscopic scar incision, and depending on how much longer the entire procedure took because of the scar incision and the strength of the urologist's documentation, you might be able to append modifier 22 (Increased procedural services) for additional reimbursement associated with the extra time she spent getting to the stone through the scar.
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