Urology Coding Alert

Question: My urologist attempted to use a laser to destroy and remove a patient's large bladder stones (52318), but because the stones were too large he had to discontinue the procedure and switch to an open removal. Can you help me with the coding for this situation?


Minnesota Subscriber

Answer: If you're submitting this procedure for payment from Medicare, report 51050 (Cystolithotomy, cystostomy with removal of calculus, without vesical neck resection) for the open procedure. If the procedure was prolonged beyond the time that your urologist would normally spend for this operation because of trying to initially endoscopically fragment the stone, append modifier 22 (Unusual procedural services).

Reasoning: The coding guidelines as outlined in the National Correct Coding Initiative indicate that when a physician needs to do two or more procedures to accomplish a surgical end, in this case the removal of a large bladder calculus, one should only code for the procedure that accomplishes this end, in this case, 51050.

Tip: Be sure to include a detailed op report and a covering letter explaining what the urologist did and why he spent so much extra time. Medicare may request this information for documentation and for the paying of the claim at an increased fee.

Alternative: Some private carriers may pay you for the open procedure and also for the discontinued laser procedure. Therefore, for private carriers you could use 51050 for the suprapubic cystolithotomy and then CPT 52318 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large [over 2.5 cm]) for the discontinued cystoscopic procedure. Append modifier 52 (Reduced services) to 52318 because the urologist discontinued the incomplete laser procedure in favor of the open removal of the stone.