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Cystourethroscopy Lithotripsy stent insertion on right side and DJ stent removal on Left Side

S

sharanyach

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5
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Dubai, DU
Dear Team,
Can we code CPT - 52356 right and CPT - 52310 Left on same day by same physician. There is NCCI edits but I have doubt as it is different Laterality and 3M also in leading giving both codes??
 
52310 cannot be unbundled from 52356 due to the 'separate procedure' designation in CPT. Even with a modifier, and even if performed on the contralateral side or at a separate encounter, this code will always be denied by payers that follow NCCI.
 
Although I agree with the above, I would also bill for the service since we are dealing with two stents, extra work, and not the removal and replacement of one stent. I would suggest the following coding for your clinical scenario:
52356-RT, and
52310-LT or XS.
Most likely the 52310 will be denied, but I would appeal with the above remarks. Also remember that carriers are now paying in an above similar example if a new stent is placed in the second side instead of a removal where this scenario was once denied.
 
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