Urology Coding Alert

Question: A patient was taken to the OR for right ureteroscopy and laser lithotripsy. The urologist treated the stones in the right ureter. She then placed a ureteral access sheath and passed the flexible ureteroscope to the right renal pelvis. She treated five separate stones throughout the kidney. How do I code for everything?

West Virginia Subscriber

Answer: Because the urologist treated multiple stones in separate structures of the urinary tract, you can report each service independently. Submit these codes and modifiers:

• 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) with diagnosis N20.0 (Calculus of kidney)
• 52353 with modifier XS (Separate structure) for Medicare or modifier 59 (Distinct procedural service) for private and commercial carriers adding diagnosis N20.1 (Calculus of ureter).

Take note: The same procedure code (52353) is allowed on both lines of your claim because the stones were in separate structures (renal pelvic stones and ureteral stones). Although anatomically the renal pelvis and ureter are continuous structures, for coding purposes they are considered separate anatomical structures.