Urology Coding Alert

Question: I’m working on an operative report for a cystoscopy in which the provider uses a jaw grasper to manually crush and remove bladder stones. Following the removal of the calculi, the surgeon performed a urethral dilation with a 22-French 10 cc Foley catheter. What CPT^® code(s) should I report?

Mississippi Subscriber

Answer: In this scenario, you’ve got to take into consideration both the cystolitholopaxy and the subsequent urethral dilation. However, you must also take into account any interfering National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits. Performing the cystolitholopaxy manually using instrumentation such as a jaw grasper, as opposed to routine equipment like an ultrasonic lithotripter, will not change the coding mechanics for this procedure.

Depending on the size and number of the bladder calculi, you’ll report one of the following codes:

• 52317 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm))
• 52318 (… complicated or large (over 2.5 cm)

As you can see in the code description, these codes include fragmentation and removal of bladder calculi “by any means.” For a typical insertion of a Foley catheter for urethral dilation, you’d report code 51702 (Insertion of temporary indwelling bladder catheter; simple (eg, Foley)). However, a quick NCCI PTP edit check reveals a modifier indicator of “0” between 52317 and 51702. This means that 51702 is bunded into 52317, without exception. In this case, report 52317 fully encompasses the services included in this operative report.