Urology Coding Alert

Question: We have a patient who had an ESWL and then came to the urologist’s office on another day to have the stones cystoscopically removed from the bladder. The stones fragments that were in the kidney now had moved down to the bladder. Patient has Medicare, and the urologist did the stone removal in the exam room. Now that they are bladder stones, would this be an unrelated procedure? How should I report it?

Ohio Subscriber

Answer: Since the bladder stone removal occurred on another encounter/day, different from the day of the extracorporeal shock wave lithotripsy (ESWL), you should use modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) to report the treatment of the stones now in the bladder since it is a new problem.

Report 52315 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated) with 79 attached since your urologist removed multiple stones.

Caution: If the bladder stone removal occurred on the same day as the ESWL, you should consider the second procedure part of the ESWL and not separately billable.