Urology Coding Alert

Question: I've been told that if a urologist does an ESWL on a kidney stone and then another ESWL on a ureteral stone during the same operative session that I cannot code both procedures, but I can charge if they are on different sides. Is this correct? Pennsylvania Subscriber Answer: You can code for both of the extracorporeal shock wave lithotripsies (ESWLs) on the same side using modifier 59 (Distinct procedural service) to indicate that the urologist used the same procedure for a stone in a different segment of the urinary tract. In this scenario your coding should be: • 50590 (Lithotripsy, extracorporeal shock wave) with a diagnosis of 592.0 (Calculus of kidney) • 50590-59 with a diagnosis of 592.1 (Calculus of ureter). Pointer: If the stones were in the left and right urinary tracts, add modifier LT for the left side and modifier RT for the right (50590-LT and 50590-59-RT).