Urology Coding Alert

Question: The urologist removed a left ureteral stone with semi-rigid ureteroscopy. He also removed a second left stone, which was a renal stone, with a flexible pyeloscopy. He performed both removals with basket retrieval with a cystoscopy placement of a ureteral stent. Can I report both stones since two different scopes were used? This patient already had recently underwent extracorporeal shockwave lithotripsy (ESWL) with stent placement, and postoperatively she developed steinstrasse, which is a column of stone fragments that form and block the ureter. So, my urologist was removing the stone fragments from the previous ESWL. Can you help me?

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Answer: When you review this scenario clinically, it appears that the stone in the ureter was caused from a fragment of the renal stone fragmented by ESWL that then passed into the ureter. The renal stone appears to be a remnant of the renal stone not completely fragmented by ESWL. Considering these facts, you should report the following codes for your second clinical scenario:

• 52352 (Cystourethroscopy, with ureteroscopy and/ or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)) with modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) appended for the staged removal of the remaining renal stone in the 90-day global of the ESWL
• 52352 with modifier 78 (Unplanned return to the operating/ procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) and modifier XS (Separate structure …) appended since the ureteral stone was a treatment of a complication of the ESWL in a different organ, the ureter
• You can also report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) if the urologist placed another stent.

Don’t miss: The second 52352 may not be paid, but it was a stone in a different noted organ with modifier XS and should be paid. Appeal if this second code is denied.