Urology Coding Alert

Question: A physician gave a referral to another urologist to perform an extracorporeal shock wave lithotripsy (ESWL). When the patient presents to the outpatient facility, the provider cannot perform the procedure because the kidney stone is too small, so the patient's procedure is canceled. How can I code this?


South Dakota Subscriber
Answer: You have two choices:

Option 1: You would report 50590 (Lithotripsy, extracorporeal shock wave) and append modifier 52 (Reduced services). The modifier signifies that the physician provided an incomplete procedure.
 
Tip: Bill electronically and only send documentation if your carrier asks. Carriers will usually make an adjustment, 10-15 percent lower payments, or ignore the modifier completely and pay the full fee. On occasion, a carrier may hold payment and request your documentation for the reduced service. Remember that you will still be in the 90-day global even if you do not complete the procedure.

Option 2: Your next option is to report any components of the procedure your physician performed if there are separate CPT codes available that do describe the part(s). In this case, if the urologist performed a renal sonogram or fluoroscopic examination, you could report 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) for the sonogram or 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) for the fluoroscopic examination.

Append modifier 26 (Professional component) to 76775 or 76000 if the patient undergoes either the sonogram or fluoroscopic examination outside of your office such as in a hospital facility or ambulatory surgery center. There are no global days associated with the renal sonogram or the fluoroscopic imaging.

Tip: The CPT Assistant advises that you not report fluoroscopic imaging separately if you are reporting the ESWL.

In addition, if the urologist counsels the patient immediately after the failed ESWL and coordinates further care for the untreated stone, bill an appropriate E/M outpatient service (99211-99215, Office or other outpatient visit ...) based on time alone.

Note: If your urologist performed part of the procedure, such as starting the shock wave lithotripsy, and then had to stop for some reason, go with code 50590-52. Always try to choose the best option for your clinical situation.