Urology Coding Alert

Question: I’m wondering what guidelines apply if the urologist completes procedures 52356 and 52352 on the same ureter or kidney. Does code 52352 include the work of 52356? And, if the same procedures are performed on a different kidney and ureter, can we report 52356 and 52352-59?

Arkansas Subscriber

Answer: You are thinking correctly in both situations. The work associated with 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) includes the work of 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)) when performed on the same structure. Therefore, in that scenario, you should bill only 52356.

If the lithotripsy and stone removal are completed on separate sites, submit both codes and append modifier 59 (Distinct procedural service) or XS (Different organ or structure) to 52352. You may also differentiate the different sides by adding modifiers LT (Left side) and RT (Right side) to the appropriate CPT^® code.

Tip: According to Correct Coding Initiative (CCI) guidelines, you can bill only one unit of service for treatment of stones per ureter or per kidney.