Urology Coding Alert

Question: I have a physician who keeps wanting to bill 52356 and 52352 together on the same side for removal of ureteral stone fragments in the bladder via a ureterscopy with lithotripsy performed during the same operative session. I feel like the 52352 should not be billed if it’s a removal of the fragments of the stone created by the 52356 procedure. Is that accurate?3

New Jersey Subscriber

Answer: You are correct that you should not report 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) and 52352 (… with removal or manipulation of calculus (ureteral catheterization is included)) together for procedures on the same side, regardless of specific anatomical location.

The code description itself states that the code encompasses cystourethroscopy, ureteroscopy, and pyeloscopy. Therefore, you should not separately report the services. “Cystoscopy lithotripsy includes all splintering of all stones within the urinary tract, regardless of location,” says John Piaskowski, CPC-I, CPMA, CUC, CRC, CGSC, CGIC, CCC, CIRCC, CCVTC, COSC, specialty medicine auditor at Capital Health in Trenton, New Jersey and surgical coding consultant at Memorial Care Health System in Huntington Beach, California.

Note: Don’t let National Correct Coding Initiative (NCCI) bundling edits confuse you. NCCI bundles 52356 and 52352 with a modifier indicator of “1,” which means you can break the bundle using a modifier such as 59 (Distinct procedural service) under certain circumstances, including different surgical sessions or sites. However, the case you describe does not meet the requirements of a different surgical session or separate location (contralateral ureter).