Wiki Cystolithopaxy with left ureteroscopy laser lithotripsy and placement of stent

[bailsb]

Hi All,

I am getting conflicting information regarding this scenario. The provider is adamant both 52356 and 52318 should be billed with proper modifiers.

OP NOTE GOES SOMETHING LIKE THIS:
26 French resectoscope utilized to enter bladder. Multiple calcifications encountered. Bladder irrigated small eggshell calcifications crushed with scope and flushed. 2 large calculi with one approx 4 cm which was broken up using thulium laser and pieces flushed. Flexible scope then placed in kidney pt had 7mm mid clayx stone with several smaller stones present. Using 200 thulium laser fiber stones dusted into smaller pieces and then flushed out of kidney. 6x24 ureteral stent placed.

Another one of my workmates reviewed this note and stated 52318 is not separately billable when performed in bladder via approach to simply get to the kidney stones for treatment.

Outside thoughts would be much appreciated.

Thank you.

 

[julieordway]

I would bill this case as 52356-(LT or RT), 52318-XS. Modifier XS would be appropriate since the stones he treated were in different organs (bladder and kidney).
Modifier usage is explained here:

https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xepsu.pdf

 

[bailsb]

Hi, I 100% agree with you. Different organ should allow to override the edit with XS. I appreciate you taking the time to look at this. Thank you.

 

[daniel]

Hi All,

I am getting conflicting information regarding this scenario. The provider is adamant both 52356 and 52318 should be billed with proper modifiers.

OP NOTE GOES SOMETHING LIKE THIS:
26 French resectoscope utilized to enter bladder. Multiple calcifications encountered. Bladder irrigated small eggshell calcifications crushed with scope and flushed. 2 large calculi with one approx 4 cm which was broken up using thulium laser and pieces flushed. Flexible scope then placed in kidney pt had 7mm mid clayx stone with several smaller stones present. Using 200 thulium laser fiber stones dusted into smaller pieces and then flushed out of kidney. 6x24 ureteral stent placed.

Another one of my workmates reviewed this note and stated 52318 is not separately billable when performed in bladder via approach to simply get to the kidney stones for treatment.

Outside thoughts would be much appreciated.

Thank you.

This is from Medicare.
This reads to me, if they treat a stone at the ureter or kidney level. Then stones fall to the bladder. You shouldn’t code it.
But if the stones are distinct, you can.

Take a look.

Regards

Medicare
CPT codes 52317 and 52318 describe litholapaxy (crushing/fragmentation and removal) of calculus in the urinary bladder. These codes may be reported for crushing/fragmentation with removal of calculi originating de novo in the urinary bladder. These codes shall not be reported for crushing/fragmentation and removal of calculi in the urinary bladder that result from a procedure to remove, manipulate, and/or fragment calculi higher up in the urinary tract.