Urology Coding Alert

Question: Is it appropriate to use modifier -59 to break the bundle between 52318 and 52353 if multiple bladder stones and one ureteral stone are broken up during the same surgical session? North Carolina Subscriber Answer: When in doubt about breaking bundles, try digging into your old philosophy-class materials consider the intent of the Correct Coding Initiative edit. It might be inferred that the intent of the edit is to stop coders from reporting both 52318 (Litholaplaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large [over 2.5 cm]) and 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) when a ureteral stone is fragmented in the ureter and pulled into the bladder where it is further fragmented, for example.

If you have separate indications or diagnoses for each code, you should be able to report both codes, especially considering the patient had two stones to begin with, and break the bundle with modifier -59 (Distinct procedural service) under the stipulation that codes can be unbundled when the procedure are performed in a different location or for separate indications. Be sure your documentation specifically identifies the reason for the use of modifier -59.