Urology Coding Alert

Question: A diagnosis of kidney stones required that we perform an extracorporeal shockwave lithotripsy (ESWL) in the hospital. The patient was given spinal anesthetic and was positioned using fluoroscopic guidance and using ultrasound so that the kidney was visible. No calcification was seen.
 
A repeat ultrasound failed to reveal any evidence of a kidney stone. Repeat fluoroscopy failed to reveal a calcified stone in the kidney area. Because there was no evidence of a stone visible on ultrasound or fluoro-scopy, the ESWL was not performed. Should I bill only for the fluoroscopy?

Minnesota Subscriber
 
Answer: You can't bill for the ESWL (50590, Lithotripsy, extracorporeal shock wave) or even use modifier -53 (Discontinued procedure) because the ESWL wasn't started.
 
Report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) for the fluoroscopy and 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) for the renal sonogram and also append modifier -26 (Professional component) if the procedures were performed in the hospital.