Urology Coding Alert

Question: One of our patients has two ureters on the left side. The doctor placed double-J stents in both of them. How should I code this?

Texas Subscriber Answer: There is no special CPT code for the passage of two stents up one ureter or two stents up a complete duplication on one side. Consider billing 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent) and appending modifier -22 (Unusual procedural services) to indicate the extra work the urologist did and boost your reimbursement accordingly. Be sure to send the operative report and a detailed explanation of what the physician did.

Another possibility: Report 52332 on one line and 52332-59 (Distinct procedural service) on a second line. But many payers might not be willing to pay for this extra catheter placement as a separate step, and will deny payment for the second stent.

For removal of more than one stent, either bilateral stents or two stents on one side, use 52315 (Cystourethroscopy, with removal of foreign body, calculus or ureteral stent from urethra or bladder [separate procedure]; complicated) instead of 52310 (Cysto-urethroscopy, with removal of foreign body, calculus or ureteral stent from urethra or bladder [separate procedure]; simple). Be aware: Code 52315 pays about $25 or $30 more than 52310.