Urology Coding Alert

Question: A patient presented with left renal colic that turned out to be a stone just above a ureteral stricture that had a moderate degree of hydronephrosis. Our physician performed a cystourethroscopy and retrograde pyelogram, a balloon dilation of the ureteral stricture, a ureteroscopic extraction of the ureteral stone, and a J-stent placement. Can any of these be billed separately?

California Subscriber

Answer: Your question confirms the difficulty coders have with the bundling in the cystourethroscopy and ureteroscopy codes, 52352 ( with removal or manipulation of calculus [ureteral catheterization is included]) in particular.

Because dilation of the intramural ureter for safe and easy placement of the instrument is bundled into code 52352, coders might assume the balloon dilation described above is also included. Wrong. Coding 52341 or 52344, as appropriate, with modifier -59 (Distinct procedural service) is reimbursable by Medicare when a true anatomic stricture is dilated.

Dissimilarly, the J-stent cannot be billed separately.

Be sure to include the diagnosis codes 592.1 for the ureteric stone and 593.3 for the stricture of the ureter.

For Medicare, the above scenario is coded: