Urology Coding Alert

Question: My doctor did a cysto, ureteroscopy, holmium laser, and stone basket extraction of five ureteral stones. Should I only bill CPT 52353 one time? Or do I bill it multiple times for multiple stones in the same ureter?

South Carolina Subscriber

Answer: You should bill 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) just once, regardless of the number of stones removed.

Keep in mind: If the number of stones fragmented and removed increased the time of the procedure significantly, such as more than an hour over what it usually takes to do such a ureteroscopic procedure, you may want to consider adding modifier 22 (Increased procedural services) to look for additional payment.

How it works: When a procedure requires significant additional time or effort that falls outside the normal range of services described by a particular CPT code -- and no other CPT code better describes the work involved in the procedure -- you should look to modifier 22. Modifier 22 represents those extenuating circumstances that do not merit the use of an additional or alternative CPT code but instead when used will raise the reimbursement for a given procedure.

Since these claims usually require manual review or an appeal in order to obtain additional payment, be sure the operative note is detailed and specific to support the medical necessity and reasons for the use of this modifier. An additional covering letter, written in layman's terms, from your urologist that presents the unusual nature of the case and the reasons for requesting additional payment will help to appeal the claim.

Watch out: Ureteroscopic stone extraction 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) is included in 52353 and should not be billed separately.