Urology Coding Alert

Question: My urologist wants to bill CPT 52353 x 2 along with the CPT 52332 because he spent so much time on a procedure to remove two stones. The entire procedure was on the same side in the same area. Can we bill the removal a second time? If so, which modifier would
be best?

Maryland Subscriber

Answer: You should not report 52353 (Cystourethro-scopy, with ureteroscopy and/or pyeloscopy; with litho-tripsy [ureteral catheterization is included]) twice for this clinical scenario. Since your urologist performed the fragmentation of two ureteral calculi during the same session, on the same side, the payer will reimburse you only once for 52353.

If the urologist had performed the lithotripsy procedure bilaterally for two stones, one in each ureter at the same encounter, you could separately report the procedures, billing 52353-50 (Bilateral procedure). Since you state that the stones were on the same side, in the same location, however, you can report 52353 only once.

Modifier help: If your urologist documented the extra time and effort he spent on this procedure because of its complexity and because it took him more time to remove both stones, you may be able to append modifier 22 (Increased procedural services) and seek extra compensation. You will need a detailed operative report and covering letter to convince the payer that you are due additional reimbursement.

You can still report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) without a modifier if your urologist also performed a stent insertion.