Urology Coding Alert

Question: My urologist performed a ureteroscopic incision of a stricture of the opening of a calyceal diverticulum and then extracted several calyceal stones. I cannot find the proper coding for this procedure. What codes do you suggest I use?


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Answer: For this case, you should report 52346 (Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture) for the ureteroscopic transureteral intrarenal incision of the stricture of the diverticular opening. Use code 593.89 (Calyceal diverticulum) as the associated diagnosis.

You should also report 52352-51 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]; multiple procedures) for the ureteroscopic transureteral extraction of the calyceal diverticular stones. You should attach modifier 51 to this code to demonstrate that the urologist performed multiple procedures during the same session.

Be sure to link ICD-9 code 592.0 (Renal calculus) to 52352. Because CPT offers no other specific diagnosis code to describe a calyceal stone, you can use 592.0 for this pathology and for calculi found in any location within the kidney. Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.