Urology Coding Alert

Question: A patient had a laser lithotripsy, and the urologist left a stent in place. She returned to the office for a stent removal, but the doctor couldn't see the stent. Kidney, ureter and bladder x-rays confirmed that the stent had migrated back into the ureter. Our doctor then performed a cystourethroscopy with ureteroscopy in the OR and retrieved the stent with a ureteroscopic grasping forceps. Any tips on how to code this?

California Subscriber Answer: When a stent has migrated up the ureter and the urologist uses a ureteroscopic removal, report the removal with 52351-22 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic; unusual procedural services). There is no specific CPT code for this removal scenario, but appending modifier -22 indicates the extra work - grasping the stent intra-ureterally and subsequently removing it.

For the diagnosis, use ICD-9 code 939.9 (Foreign body in genitourinary tract; unspecified site).

Hidden trap: You may need to drop this claim to paper. Typically, claims with modifier -22 are automatically denied, with a request for more information explaining the circumstances requiring the modifier. Rather than waiting for the denial and request for supporting documentation, you may be better off submitting the claim on paper with the progress notes or procedure report already attached. - Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 21-urologist practice in Indianapolis.