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Urology Coding Alert

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When Is 52353 x 2 Appropriate?

Published on Fri Nov 27, 2009

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 [...]
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