Urology Coding Alert
Lithotripsy and Stone Removal
Illinois Subscriber
Answer: Although many urologists feel they should be allowed to bill both, as per the Correct Coding Initiative, 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) can never be unbundled from 52353 ( with lithotripsy [ureteral catheterization is included]). However, the urologist can bill 52320 (Cystourethroscopy [including ureteral catheterization]; with removal of ureteral calculus) with 52353. For these two codes, there are no prohibitive edits. When removing multiple stones using either 52320 or 52352, add modifier -22 (Unusual procedural services) to indicate the work involved. Use modifier -22 based on the work involved to remove the stones, not the number of stones.
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