Wiki One stone, two forms of fragmentation

[JenLawson]

Hi all,
I have a situation in which the surgeon started with lithotripsy using holmium laser to fragment a stone that was impacted in the proximal ureter. Once the laser was engaged the stone move into the kidney. At this point the surgeon disengaged the laser, place a stent, and removed the scope. He then switched to ESWL to complete the stone fragmentation.
He coded 50590 and 52356 to account for both methods of fragmentation used.

My question is: Can I code for both methods of fragmentation, or should I use only the code for the one that successfully fragmented the stone?
I would appreciate any resources documenting how this situation should be handled, if possible.

Thanks,
Jennifer

 

[kvangoor]

No, you cannot bill for both. There is a CCI edit that bundles both of these services on the same day for the same patient. Most payers will only consider payment on the 50590.

 

[JenLawson]

Thanks! I was thinking that was likely the case, just wanted to be sure.

 

[nomie7]

I have this same situation. Thoughts on also billing 52332 in addition to 50590?