Urology Coding Alert

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Question: How should we code for removal and replacement of double-J stents through an ileal conduit when the bladder has been removed? Illinois Subscriber   Answer: You should use CPT 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) with modifier -52 (Reduced services) to indicate stent placement without cystoscopy. In this procedure, the bladder has been removed and the stents are either within the intestinal segment or exiting onto the skin from the intestinal opening (stoma). The urologist places a guidewire into the lumen of the stent, advancing it to the kidney and to the end of the stent under fluoroscopic control.

The guidewire is held in place, and the urologist removes the stent. A new stent is passed over the wire and the wire removed, leaving the new stent in place. The removal of the old stent CPT 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) has recently been bundled into 52332, and no modifier can unbundle it. If performed with fluoroscopy, also report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) with modifier -26 (Professional component) if performed in the hospital. If two stents are exchanged, report 52332-50-52 (Bilateral procedure).

If exchanging the stents by looposcopy (looking into the intestinal segment replacing the bladder, through the stoma with a scope), do not use 52332. Instead, bill 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with modifier -22 (Unusual procedural services). If exchanging two stents, do not use modifier -50 because modifier -22 explains the extra work.