Urology Coding Alert

Question: If a patient had an ESWL and two days later requires admission for pain, how should I bill?

North Carolina Subscriber  
Answer: CPT 50590 (Lithotripsy, extracorporeal shock wave) (ESWL) has a 90-day postoperative period. Control and management of postoperative pain is included in the surgical package and is not chargeable. Carriers will not pay for this postoperative pain management. If further surgery is required in the operating room (OR), this may be payable: For example, a stent (52332) is required. Use ureteral stone (592.1) or renal colic (788.0) for the stent, and append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 52332, indicating a surgical treatment for a complication performed in the OR. 
 
If, however, the pain is secondary to a stone in the contralateral kidney, code the admission with modifier -24 (Unrelated E/M service by the same physician during a postoperative period) appended. If the patient requires a return to the OR, bill with modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) appended to the surgical procedure indicating an unrelated procedure on the contralateral kidney.