Urology Coding Alert

Question: Our patient has bilateral ureteral stones. The doctor did a cystoscopy, ureteroscopy with lithotripsy and stone extraction on the left side, and a cystoscopy, ureteroscopy with stone extraction on the right. He placed bilateral ureteral stents. How should I code this?

Texas Subscriber

Answer: First, report 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]), with modifier LT (Left side) appended, for the left-side ureteroscopy, lithotripsy, and stone extraction. Next, you'll code the ureteroscopy and stone extraction on the right side using 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus ...). Append modifier 51 (Multiple procedures) to indicate the urologist performed multiple procedures and modifier RT (Right side) to show the location.

Finally, report 52332-50 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]; bilateral procedure) for the bilateral double-J stent insertions.

Caution: The Correct Coding Initiative (CCI) bundles 52352 into 52353, and you cannot bypass this edit with any modifier. Therefore, Medicare and other carriers following the CCI will deny payment for 52352-51-RT and only pay you for 52353-LT and 52332-50.

Although your urologist performed these procedures at the same time and CCI bundles them, you should appeal the denial. These stones were in two different locations, and your physician treated separate anatomic parts of the urinary tract. Consequently, you should get paid for both treatments.

Tip: To indicate the different anatomic locations, append modifier 59 (Distinct procedural service) to 52352. With an appeal and the proper documentation, you should see payment.

Alternative: Non-Medicare carriers may require 52332-LT on one line and 52332-50-RT on a second line for the bilateral stent insertions. You should check with the carrier to discern its coding preference for bilateral procedures.