Urology Coding Alert

Question: My urologist spent five hours with a patient performing the following: extracorporeal shock wave lithotripsy (ESWL), cystoscopy with retrograde pyelogram, ureteral stent placement, lithotripsy of calcified distal left ureteral stent, and ureteroscopy with a laser lithotripsy of midureteral stone fragment. How should I report these procedures?


Minnesota Subscriber

Answer: You should first report 50590 (Lithotripsy, extracorporeal shock wave) for the lithotripsy procedure because this is the primary procedure with the highest RVUs. If the urologist performed the procedure on both sides, append modifier 50 (Bilateral procedure) to indicate that.

Next, use 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureter catheterization is included]) for the ureteroscopic mid-ureteral stone fragmentation.

You also need to attach modifier 59 (Distinct procedural service) to 50590 to unbundle 50590 and 52353.
 
Next, report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) for the placement of the stents. Attach 59 to 52332 to break the bundle with 52353 and, again, if the urologist completed the procedure on both the right and left sides, append modifier 50.

Also, if your physician interpreted the retrograde pyelogram, you should add 74420 (Urography, retrograde, with or without KUB). Append modifier 26 (Professional component) to this code to indicate that the urologist only interpreted the results.