Urology Coding Alert

Question I am trying to code an unusual procedure for the removal of a calcified ureteral stent. Practitioner wants me to code for the right extracorporeal shock wave lithotripsy (ESWL) using 50590, the cystourethroscopy with removal of ureteral stent using 52310, and the cystourethroscopy with urethral catheterization with 52005. How should this be coded?

Procedure: A cystoscope was passed per urethra and the stent was grasped. At this point, the ESWL was performed. While performing the ESWL, I was pulling gently on the stent. At 61 shocks, provider was able to remove the stent completely from the patient. A right-side retrograde pyelogram was then performed. Contrast was injected through a catheter in the right ureter. The patient was noted to have moderate right hydroureteronephrosis all the way to the level of the bladder. Efflux of contrast was noted with the catheter and the bladder was drained.

California Subscriber

Answer: “I checked the Medicare NCCI edits. Depending on what insurance this claim is for, 50590 [Lithotripsy, extracorporeal shock wave] can be reported. CPT® 52005 [Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service] can also be submitted with modifier 59 [Distinct procedural service] added, but documentation must support that is a separate procedure and medical necessity must be included. CPT® 52310 [Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple] cannot be reported with 52005 as it is included with CPT® code 52005 and no modifier is allowed,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, urology coding expert and consultant in Glen Burnie, Maryland.