Urology Coding Alert

Question: My urologist performed two ESWLs and stent placement on a nine-year-old patient who had multiple stones. With such a large stone burden, the doctor had to go back and do a ureteroscopy and stone extraction. Can I report 52353-78 multiple times? Also, what diagnosis code should I use?

Alabama Subscriber

Answer: You should report 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) rather than 52353 (... with lithotripsy [ureteral catheterization is included]) for the second procedure since your urologist did not perform a fragmentation procedure. Append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) since this encounter is related to the original surgery (a complication) but still within the global period of the extracorporeal shock wave lithotripsy (ESWL) procedures and stent placement.

Helpful hint: You can report 52352 on separate days as many times as you need since this code has a zero-day global period. You should attach diagnosis code 592.1 (Calculus of ureter) for this procedure.