Urology Coding Alert

Question: I bill for an ASC and the surgeon performed a bilateral ureteroscopy then a left ESWL. The ureteroscopy was diagnostic. Fluoroscopic evaluation confirmed a stone in the left lower pole. After these studies the urologist opted to perform an ESWL on the left side. Is the diagnostic ureteroscopy included in the charge for the ESWL or should I bill for the ureteroscopy with modifier 59? I’m thinking 52351 is included in 50590.

New Mexico Subscriber

Answer: If the ureteroscopy, an endoscopic procedure, was truly a diagnostic procedure and led to the decision to perform an extracorporeal shockwave lithotripsy (ESWL), you can bill both procedures.

First, report 50590 (Lithotripsy, extracorporeal shock wave) for the ESWL procedure. Then, report 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy, diagnostic) for the ureteroscopy. Append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 52351. This indicates that this procedure was in fact diagnostic and responsible for the choice of future therapy, ESWL.

Caveat: If the ureteroscopy was only confirmatory for the presence of the renal calculi initially diagnosed by sonography and was not responsible for the treatment choice, just bill 50590 and not for the “scout ureteroscopy,” which was really just an examination/review of the operative field.