Wiki ESWL- same side -2 stones

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1CodingTeam24

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Hello,

I am looking for a little help from anyone who might have already had this same scenario before. I have someone who has is having an ESWL-50590 and they ended up having 2 stones treated in 2 separate locations on the same side-RT. One of the stones is a staged procedure from a previous treatment and one stone is a new stone being treated for first time. How would this be billed to get the most reimbursement?

Thanks
 
No Go Litho

Hi lambert82!,

I know it feels bad not charging for the additional work, but typically when billing 50590, I have found regardless of placement in the kidney/ureter, if it is on the same side it's only one code. Of course if it was the opposite side then you could bill with your RT,LT modis, or 50 depending on how your carrier likes their claims. If your doctor feels as if he put in more time and work I would suggest he document that as some commercial payers would possibly consider the use of the 22 modifier for increased service.
If he were using a ureteroscope and laser (52353), its possible that you could bill the scenario you have given based on the payer. *MCR forsure doesn't allow this type of billing.


The AUA has an article online about this. It maybe a little dated, but i still find it very beneficial.
Good Luck to you!

http://urologytimes.modernmedicine....-cpt-52356-removing-multiple-stones?page=full
 
I have this occur quite frequently. I would recommend the -22 modifier in order to obtain ANY additional payment. But the doctors documentation should reflect the time extra spent on the patient because of the two stones. You cannot bill it on same side with a -59 using N20.0 & N20.1 stones. The code N20.2 in this case should be used.
 
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