Urology Coding Alert

Question: We are unsure whether we can bill a ureteroscopy and stent insertion separately. Can you help?

Anonymous California Subscriber

Answer: As long as the stent is permanent, and not temporary, you can bill it separately. Temporary stents are often placed as part of the endoscopic procedure (see 52320-52339) and cannot be reported in addition. But an indwelling stent, which is placed during the procedure to keep the ureter open and to assist recovery after the procedure, can be billed separately.

Sometimes the patient has a stone that is in the ureter and is too large. First the physician must use the cystoscope to remove the stone. Then there is usually some swelling. The physician puts the stent in to keep the ureter open.

For this case, bill the ureteroscopy code (52335, 52336, 52337, 52338 or 52339) and 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Append modifier -51 (multiple procedures) to 52332 to indicate that you have performed a multiple procedure. You must also append modifier -59 (distinct procedural service), because 52332 is bundled with 52320-52339.

The modifier -59 will tell the payer that you are inserting an indwelling, not a temporary, stent.

The introduction to the ureter and pelvis section of CPT states the following: To report insertion of a self-retaining, indwelling stent performed during cystourethroscopic diagnostic or therapeutic intervention(s), use code 52332, in addition to primary procedure(s) performed, and append the modifier -51. Code 52332 is used to report a unilateral procedure unless otherwise specified. Put the ureteroscopy code on the first line, and 52332-59-51 on the second line. Note that if you perform this procedure bilaterally, you should use modifier -50.