Wiki 52356 and 52352 XU

[RDCoder]

physician did a cystourethroscopy, retrograde ureteral pyelography, ureterscopy, holmium laser lithotripsy, basket stone extraction, and double j stent insertion. Would the basket extraction be coded separately with the 52352-XU? It is not excluded from 52356.

Thank you for your help

 

[drewvinson23]

The basket extraction is separately reportable if it is done to a separate stone in a separate structure. For example, if the provider does lithotripsy of a ureteral stone, and then does basket removal of a separate kidney stone. In these cases, the most appropriate modifier would probably be XS, for separate structure or site.

If the basket extraction is of pieces of a stone that the provider broke up, or is removal of stones in the same structure as the lithotripsy, then it is not reportable. For example, the provider does lithotripsy to stones in the kidney and then uses the basket to remove the pieces of the stone, or other stones in the kidney, then it is not reportable.

Be aware, we have seen some denials from insurance companies that seem to only allow multiple stone procedures to be reported on if they are done on different sides of the body. For example, some payers will not allow reporting of 52356-RT and 52352-XS-RT even if the stones are distinct and in separate structures. You will have to check with your payers about their particular edits in this regard.

Here is a good article that outlines reporting of multiple stone procedures:

http://www.urologypracticetoday.com/billing-for-multiple-stones/

Hope this helps,

Drew Vinson
CPC
NW Urology

 

[RDCoder]

Thank you very much for your help, I have done so much research and came up with a yes on another article with no mention of side. I am covering for our Urology coder while she is out this month and this on has really got to me.

Very much appreciated,
Rebecca