Urology Coding Alert

Question: One of our patients was scheduled for an ESWL (which I would normally code as 50590). During the procedure, the urologist treated two kidney stones in two separate locations within the right kidney. One of the stone treatments was a staged procedure from a previous ESWL treatment less than 90 days ago; the other stone was a new stone being treated for the first time. How would this be billed to get the most accurate reimbursement?

Maine Subscriber

Answer: When billing 50590 (Lithotripsy, extracorporeal shock wave), you should only bill one code for the treatment of multiple stones on the same side, regardless of stone location in the kidney or ureter. In this case since an initial ESWL was performed less than 90 days ago (ESWL has a 90-day global period), and to ensure payment, add modifier 58 (Staged or related procedure...) to the second ESWL code as 50590-58.

If the stones were on both sides, you could bill with modifiers RT (Right side), LT (Left side) or 50 (Bilateral procedure) as applicable, depending on how the payer prefers the claim be submitted. In the above case scenario, include diagnosis N20.0 (Calculus of kidney).

If your doctor feels he put in more time and work than usual in fragmenting the multiple kidney stones, consider appending modifier 22 (Increased procedural services) with strong supporting documentation of the extra work and time spent.