Wiki Question on how to bill for Lithotripsy's bilateral

[carol52]

Hello, I have a surgery that had both Ureters with Ureteroscopy with laster lithotripsy and double J stent placed
and also had Bilateral Renal pelvis with laser lithotripsy. I need help in billing these procedures out.
52356 includes the stent but can both the ureters and the renal pelvis be billed ?
Thanks,
Carol McRoberts

 

[sxcoder1]

Yes, the ureter and renal pelvis are considered separate structures, so you can bill 52356-50 and 52353-50 (you can't bill the stent twice) and will have to append either modifier 59 or XS depending on the insurance. And of course you will use N20.0 for one and N20.1 for the other.

 

[thomas7331]

Yes, the ureter and renal pelvis are considered separate structures, so you can bill 52356-50 and 52353-50 (you can't bill the stent twice) and will have to append either modifier 59 or XS depending on the insurance. And of course you will use N20.0 for one and N20.1 for the othe

I disagree - this contradicts the CPT guidance under these code descriptions: "Do not report 52356 in conjunction with 52332, 52353 when performed together on the same side."

Only one of these lithotripsy codes should be reported per side regardless of how many stones were treated. I would code this 52356-50 for the entire procedure, as has been described here.

 

[carol52]

I disagree - this contradicts the CPT guidance under these code descriptions: "Do not report 52356 in conjunction with 52332, 52353 when performed together on the same side."

Only one of these lithotripsy codes should be reported per side regardless of how many stones were treated. I would code this 52356-50 for the entire procedure, as has been described here

thank you, I had a discussion with my coding manager about this he thought that I could bill out the 52356 -50 and also the 52353 XS, but I read on the AHA Coding Clinic References that it instructs

users to not report code 52356 in conjunction with codes 52332 and 52353 when performed on the same side, because the procedure described by code 52356 includes both the insertion of the indwelling ureteral stent and
the Lithotripsy as described in code 52353. Therefore, code 52356 would be reported for the entirety of the scenario presented. So I did have the 52352 added for a charge but have removed it since reading this
also along with your reply. Thank you for you time !