Wiki 52310 special circumstance and coding problems

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afanene

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Special situation for this particular code our office bills fairly often with no issue.

Back story: Pt is in 90 day global for surg and has bilateral indwelling stents and is set up for a post op apt to have both removed. During the removal the RT side becomes lodged and unable to remove. Doctor decides to take pt to OR to have the remaining stent removed.

We billed POS 11 (office) and 52310 with mod 58

AND POS 24 (surgery center) with code 52310 mod 78, XE, RT

The POS 24 was paid and the office billing denied for inappropriate place of service.

HOW DO I FIX THIS SO WE CAN GET PAID FOR THE OFFICE STENT REMOVAL?

Has anyone had this happen in their office and got paid? If so how? Or any suggestions?
 
what is your 90 day global charge? ESWL 50590?

Since the insertion of the stent 52332 has zero days & the removal of the stent is related to that surgery not the ESWL the modifier should be 79 unrelated to the ESWL not 58 or 78.
Use RT & LT indicating which ureter was done where and add XS for different organ

52310 can be done in the office so I would check with the carrier why they are denying for POS. Also use the complication code for the dislodged stent T83.122A

Office should be 52310-RT (if that is the side) 79 (unrelated to ESWL) ,XS (different organ)

Hospital should be 52310-LT,79,XS

You may have to appeal with the office & hospital notes to indicate what happened.
 
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