Urology Coding Alert

Question: The physician used fluoroscopic guidance to place two stents on the right side, one in the upper pole and one in the lower pole of a complete duplication of the right urinary system. Can we bill out for both stents? 

Wyoming Subscriber

Answer: This coding scenario often was not reimbursed in the past. However, with the new X{EPSU} modifiers, you might have a better chance of explaining the situation to the payer and gaining payment. Submit 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) on line one of the claim and with 52332-XS (Separate structure) on line two. Modifier XS is appropriate because the surgeon placed the second stent in a separate structure – the duplicated ureter. Fluoroscopic guidance is included in code 52332.  Associate the procedure code with diagnosis Q62.5 (Duplication of ureter).