Urology Coding Alert

Question: A patient had outpatient surgery that included lithotripsy (50590) with stent insertion (52332). The staff was not able to discharge him from recovery because they could not control the stent pain. On the same day he returned to the operating room for a second session to remove the original stent (52310) and replace it (52332). Is there a returned to the operating room modifier we could bill to get reimbursed for this patient, or can both encounters even be billed since it was two separate sessions on the same day?

Vermont Subscriber

Answer: Yes, you have several modifier choices that can be appropriate, depending on the circumstance:

• Modifier XE (Separate encounter)
• Modifier 76 (Repeat procedure or service by same physician or other qualified health care professional)
• Modifier 77 (Repeat procedure by another physician or other qualified health care professional).

The procedure codes for the patient's first encounter are 50590 (Lithotripsy, extracorporeal shock wave) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Report the second encounter's work as 52332 -76. In this case this CPT® code would include the removal of the initial stent and its replacement (stent exchange).