Wiki 52005?

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toria11

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The physician wants to bill 52005 here but I don't see enough evidence in the documentation that the ureter was catheterized. Wires cannot be billed for, correct? And 76000 is bundled with 50590. Thoughts?

The patient was brought into the OR and placed in dorsal lithotomy position on the lithotripsy table. I then performed cystoscopy with the rigid scope and noted a normal urethra and bladder. I then passed a wire into the left ureteral orfice so that it allowed me to identify the left ureteral calculi.
The patient was then re-positioned to a supine position. The stones , up to 8 cm in total length, were visualized in the left ureter by fluoroscopy. The patient then underwent left ESWL using the Wolf machine. A total of 3500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
I then re-positioned the machine to treat the left renal calculi. The stones, up 0.9 cm in size, were visualized in the left kidney by fluoroscopy. The patient then underwent left ESWL using the Wolf machine. A total of 2500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
 
50590.LT only.
I would just inform the provider CPT 76000 + 52005/52000 is inclusive per CCI edit.

The patient was brought into the OR and placed in dorsal lithotomy position on the lithotripsy table. I then performed cystoscopy 52000 with the rigid scope and noted a normal urethra and bladder. I then passed a wire into the left ureteral orfice so that it allowed me to identify the left ureteral calculi.
The patient was then re-positioned to a supine position. The stones , up to 8 cm in total length, were visualized in the left ureter by fluoroscopy. The patient then underwent left 50590 ESWL using the Wolf machine. A total of 3500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
I then re-positioned the machine to treat the left renal calculi. The stones, up 0.9 cm in size, were visualized in the left kidney by fluoroscopy. The patient then underwent left ESWL using the Wolf machine. A total of 2500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
 
daniel said:
50590.LT only.
I would just inform the provider CPT 76000 + 52005/52000 is inclusive per CCI edit.

The patient was brought into the OR and placed in dorsal lithotomy position on the lithotripsy table. I then performed cystoscopy 52000 with the rigid scope and noted a normal urethra and bladder. I then passed a wire into the left ureteral orfice so that it allowed me to identify the left ureteral calculi.
The patient was then re-positioned to a supine position. The stones , up to 8 cm in total length, were visualized in the left ureter by fluoroscopy. The patient then underwent left 50590 ESWL using the Wolf machine. A total of 3500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
I then re-positioned the machine to treat the left renal calculi. The stones, up 0.9 cm in size, were visualized in the left kidney by fluoroscopy. The patient then underwent left ESWL using the Wolf machine. A total of 2500 shocks were given during the procedure. The stone appeared to fragment well during the procedure. There was minimal flank bruising. The patient tolerated the procedure well.
Click to expand...
Even so, 52005 is not documented here, correct? Just making sure I'm not missing something. All I saw was 52000. This patient also has a commercial plan, so it's possible that they will pay for the 50590 for both the kidney and the ureter. My other suggestion was to use modifier 22 for the extra effort of repositioning the machine and treating a second stone in a different organ. Thanks for your time!!
 
I would code 50590.LT only. No modifier 22, that wire may be a indication he did 52005. Which would lead to a query for an addendum for insertion of a cath into this area to support 52005. But with this documentation, there's not enough to support 52005.

Hope this helps
Regards,
 
daniel said:
I would code 50590.LT only. No modifier 22, that wire may be a indication he did 52005. Which would lead to a query for an addendum for insertion of a cath into this area to support 52005. But with this documentation, there's not enough to support 52005.

Hope this helps
Regards,
Click to expand...
Gotcha, thanks for the clarification on the 52005!! I do disagree with 50590-LT only, because it does take additional time/effort to reposition the machine and treat a stone in another organ. And it can be billed with a 22 or possibly even 2 units with an XS if the payer accepts.
 
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