Urology Coding Alert

Question: Could you please tell me how to code for these procedures and get paid by Medicare: 52332, 52315 and 52310. Our doctor removed ureteral stents bilaterally and inserted stents bilaterally.

Indiana Subscriber

Answer: These procedures are not bundled together, so you can get paid for both of them. However, you can not get paid for both of them twice. You cannot bill twice for 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple). You can bill 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) twice, however, by adding modifier -50 (bilateral procedure).

Therefore, the proper way to code for these procedures is 52310, 52332-50. If the removal of the stents took longer than 15 minutes and this was documented, the removal would be considered complicated. Consequently, code 52315 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; complicated) would be reported instead of 52310.

There is no guarantee that you will be reimbursed separately for the removal of the stents as individual third-party payers may have edits that prohibit payment under any circumstances. Based on the CPT description, codes 52310-52315 are separate procedures and, therefore, bundled into another, more comprehensive, service (e.g., stent insertion). Per CPT guidelines, modifier -59 is attached to the separate procedure code when the procedure is a distinct, independent procedure represented by, among other things, a separate incision/excision (scope inserted twice).