Urology Coding Alert

Question: How should I code for incising the neck of a caliceal diverticulum and the extraction of a caliceal stone?

New Jersey Subscriber  
Answer: First bill 52346 (Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture [e.g., balloon dilation, laser, electrocautery, and incision]) for incising the infundibulum of the diverticulum and 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) with modifier -51 (Multiple procedures) appended for the stone removal. A double-J stent is often placed; use 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type) with modifier -51 appended for the stent. If the procedure is performed under fluoroscopy, also report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) with modifier -26 (Professional component) appended for the radiological reading of the film. Use 593.89 (Other specified disorders of kidney and ureter; other) for the incision (52346) and 592.0 (Calculus of kidney) for the calculus extraction (52352). Because the stent is to prevent hydronephrosis, link 52332 to 592.0.
  Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver.