mkscrivner
New
How are you billing for bilateral ureteral stent removal since 52310 does not accept modifier 50? Any help is much appreciated! 
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Wiki Removing bilateral ureteral stents!
- Thread starter mkscrivner
- Start date
l1ttle_0ne
Guru
You would just bill the 52310 once.
YmbcoderII
Contributor
Bilateral stent removal?
Code 52315
Code 52315
ckkohler
Guru
We also use 52315 for removal of bilateral stents in our Urology practice/ASC.
tori_ryan24
Contributor
Hi just a question on this bc I am completely surprised. So when you bill the52315 you don't have problems with records requested medical documentation support request?
I have thought about using this code because we have so many problems with them paying the 52310 but my doctor should be reimbursed (I feel) for the work he is doing bilaterally.
I have thought about using this code because we have so many problems with them paying the 52310 but my doctor should be reimbursed (I feel) for the work he is doing bilaterally.
I have only been able to bill and get reimbursed for 52310. Cahaba considers only one code with no modifiers because you already have the scope inserted in the patient and can do them both at the same time. I have tried before to use a LT and RT, but was denied.
JEYCPC
Expert
I agree w/emcee.
52310 is all you can bill for bilateral stent removal.
YmbcoderII
Contributor
Bi-lateral stent removal - 52315
Reader Questions: No Billing Bilaterally for Stent Removal
- Published on Mon, Mar 28, 2005
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For my Urologists, I bill 52315 and receive reimbursement as a result of the following:
Per Urology Coding Alert / SuperCoder.com:
Question: Recently, the urologist removed bilateral stents in the office. I submitted a claim with CPT 52310 -LT and 52310-RT. Medicare only paid us for one side, though. How can we get full reimbursement?
West Virginia Subscriber
Answer: CPT code 52310 (Cystourethroscopy, with removal of foreign body, calculus or ureteral stent from urethra or bladder [separate procedure]; simple) has a bilateral modifier indicator of "0," meaning that Medicare considers the bilateral payment adjustment inappropriate for this procedure.
Medicare will only pay for one procedure (or for the amount you bill for both procedures, if it's less than the Medicare Fee Schedule amount for one).
For this scenario, use the complicated removal CPT code, 52315 (... complicated). The removal of more than one foreign body or stone would fall into this category.
Hope this helps!
Reader Questions: No Billing Bilaterally for Stent Removal
- Published on Mon, Mar 28, 2005
--------------------------------------------------------------------------------
For my Urologists, I bill 52315 and receive reimbursement as a result of the following:
Per Urology Coding Alert / SuperCoder.com:
Question: Recently, the urologist removed bilateral stents in the office. I submitted a claim with CPT 52310 -LT and 52310-RT. Medicare only paid us for one side, though. How can we get full reimbursement?
West Virginia Subscriber
Answer: CPT code 52310 (Cystourethroscopy, with removal of foreign body, calculus or ureteral stent from urethra or bladder [separate procedure]; simple) has a bilateral modifier indicator of "0," meaning that Medicare considers the bilateral payment adjustment inappropriate for this procedure.
Medicare will only pay for one procedure (or for the amount you bill for both procedures, if it's less than the Medicare Fee Schedule amount for one).
For this scenario, use the complicated removal CPT code, 52315 (... complicated). The removal of more than one foreign body or stone would fall into this category.
Hope this helps!
Codergirl93
Networker
52310 should be used
I looked on SuperCoder as well and I found a statement where is says CPT 52315 should be used when the provider has a much more difficult time to the point where the urologist has to "dig" the forgien body out. So to me I think the 52310 should be used when there is no complications during the removing and only use 52315 when there is complications.
Yes you may get reimbursed now but you always have that chance that the insurance company will recoup the money because the documentation does not support the CPT coded used. I am certified in Urology coding and I don't even use 52315 when two sents are being removed because there is nothing complicated about the removal. So I would really watch which CPT code you pick because never know when you might get audited by Medicare or the OIG.
I looked on SuperCoder as well and I found a statement where is says CPT 52315 should be used when the provider has a much more difficult time to the point where the urologist has to "dig" the forgien body out. So to me I think the 52310 should be used when there is no complications during the removing and only use 52315 when there is complications.
Yes you may get reimbursed now but you always have that chance that the insurance company will recoup the money because the documentation does not support the CPT coded used. I am certified in Urology coding and I don't even use 52315 when two sents are being removed because there is nothing complicated about the removal. So I would really watch which CPT code you pick because never know when you might get audited by Medicare or the OIG.