Urology Coding Alert

Question: A patient had two stones: one in his kidney and one in his ureter. The urologist did a cystoscopy with a pushback and stent placement on the ureteral stone, after which he treated both stones with ESWL. Can I report 50590, 52332 and 52330?


Idaho Subscriber

Answer: Yes, you can--and should--report all three codes for the procedure your urologist performed.

First, report 50590 (Lithotripsy, extracorporeal shock wave) for the extracorporeal shockwave lithotripsy (ESWL) of the renal calculus and the displaced ureteral calculus that the urologist moved into the renal pelvis.

Next, report 52330 (Cystourethroscopy [including ureteral catheterization]; with manipulation, without removal of ureteral calculus) for the cystourethroscopy and manipulation of the ureteral stone into the renal pelvis. The Correct Coding Initiative (CCI) bundles this code into 50590, but you can break the bundle in this case by appending modifier 59 since there were separate stones (Distinct procedural service). You'll also need to append modifier 51 (Multiple procedures) because your urologist performed more than one procedure during the same operative session.

Note: You aren't required to append modifier 51 on a Medicare claim because the carrier will automatically add them, but it doesn't hurt to do so.

Finally, you should report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) for the double-J stent placement. As of April 1, 2007, CCI no longer bundles this code into 52330. Append modifier 51 to 52332 as well.