Urology Coding Alert

Question: How can we bill for a stent placed three days after an extracorporeal shock wave lithotripsy (ESWL)?

Oregon Subscriber

Answer: Code CPT 50590 (lithotripsy, extracorporeal shock wave) has a 90-day global, so stent placement would normally not be covered. But Medicare would view the need for a stent, such as a stone obstructing the ureter, as a complication, and therefore you should append modifier -78 (return to the operating room for a related procedure during the postoperative period) to 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]), providing that the patient did go back to the operating room for stent placement for a stone that is obstructing the ureter after the ESWL. Private payers, however, would view this as a new problem, and therefore you should append modifier -79 (unrelated procedure or service by the same physician during the postoperative period) to 52332. Because some private payers dont accept modifier -79, you can resubmit the claim with modifier -78 if the patient was brought to the operating room. And if the stent was placed elsewhere, try modifier -58 if the original documentation indicated the possible need for stenting later. Medicare will not pay for any postsurgical complications treated out of the operating room.


Answers to You Be the Coder and Reader Questions were provided by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Health Science Center, Stony Brook, N.Y.; and Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and compliance consultant specializing in urology and based in Denver.