Wiki Modifiers on an ESWL and Ureteroscope/Laser in same op session

Jessim929

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Hi All -

I have an ongoing debate with a colleague regarding how to bill stone procedures. When they do a combination therapy in the same op session, I bill it as 50590-<laterality>, 52356-59(XU same stone/XS separate stone) - <laterality> and I don't see denials. She swears left, right, and sideways that she was told NEVER do the 59 modifier, do 58 instead. My understanding of the -58 modifier is that it's used on planned subsequent procedures in separate operative sessions, not in the same surgery. Yet, she doesn't understand why hers get denied so often.

How do you bill these? Thanks!
 
If your clinical scenario represents a renal stone and a ureteral stone on the same side, I would suggest the following coding:

50590 for the renal stone, diagnosis N20.0, and
52356 XS for the ureteral stone diagnosis N20.1

If the stones are on different sides, I would suggest:
50590-RT
52356-XS-LT

Modifier-58 is used for staged procedures usually on separate encounters which is not the case you described
 
That's what I thought, I'm glad I'm not losing my mind!

Thank you so much Dr. Ferragamo!
 
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