Wiki 52356 with 52353

[daknaack]

I am wondering if anybody ever bills these 2 codes out together?
I know that CPT states not to when performed on the same side, but at the same time, that doesn't make sense when the physician is treating stones in 2 separate structures (kidney & ureter), so I'm just curious if anybody bills that way and has success? Or am I just asking for a denial?
Thank you!

 

[sxcoder1]

We bill those out as well if it's 2 separate structures. Sometimes we have success and sometimes not!

 

[thomas7331]

Both CPT and the NCCI manual are very clear about this in that lithotripsy procedures may only be reported once per side, not per stone. In my opinion, the only legitimate reason that would support the use of a modifier to unbundle these would be if the two procedures were performed on contralateral sides.

Per the NCCI manual:
"The UOS for a procedure describing destruction or removal of renal system calculus(i) is one. The unit of service is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, the CPT code may be reported with modifier 50 and one unit of service.

For example, CPT code 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)) shall be reported with only one UOS per ureter regardless of the number of calculi in the ureter. If the procedure is performed on bilateral ureters, it may be reported with modifier 50 and one unit of service. This code shall not be reported with a separate unit of service for each calculus."

 

[liqgold2@aol.com]

If you treated a stone in the kidney and one in the ipsilateral ureter, I would suggest the following coding;
52356 for the fragmentation of the renal stone, its removal, and the placement of a JJ stent, and
52353-XS fragmentation of the stone in the ipsilateral ureter. The ipsilateral ureter in this case is considered a separate structure by the AUA and CPT and therefore, requires modifier- XS, indicating the separate structure, for payment of both procedures.