Urology Coding Alert

Question: Recently, the urologist removed bilateral stents in the office. I submitted a claim with CPT 52310 -LT and 52310-RT. Medicare only paid us for one side, though. How can we get full reimbursement?

West Virginia Subscriber

Answer: CPT code 52310 (Cystourethroscopy, with removal of foreign body, calculus or ureteral stent from urethra or bladder [separate procedure]; simple) has a bilateral modifier indicator of "0," meaning that Medicare considers the bilateral payment adjustment inappropriate for this procedure.
 
Medicare will only pay for one procedure (or for the amount you bill for both procedures, if it's less than the Medicare Fee Schedule amount for one).
 
For this scenario, use the complicated removal CPT code, 52315 (... complicated). The removal of more than one foreign body or stone would fall into this category.