Urology Coding Alert

Question: My urologist performed a cystoscopy with a retrograde pyelogram and inserted two left ureteral stents because the patient has a duplicated ureter. What CPT code or modifiers should I use for this unique scenario?Arizona SubscriberAnswer: There is no specific coding for placing two ureteral stents into one ureter or two stents into a duplicated ureter on one side. Most carriers won't reimburse any more under these circumstances than they will for one insertion.Regardless of whether your carrier will pay you for both insertions, you should still code both procedures to accurately represent what your urologist did.First: Report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) with the appropriate diagnosis code. For example, the urologist may be placing the stent for hydronephrosis (591).Next: Report 52332 again for the second stent insertion. Append modifier 59 (Distinct procedural service) to indicate that this was not a double charge but a stent placement in another part of the urinary tact. Your diagnosis code for this part of the procedure should be 753.3 (Other specified anomalies of kidney) for the duplicate ureter.Alternative: You may also try reporting 52332 with modifier 22 (Increased procedural services) appended rather than reporting 52332 twice using modifier 59. If you choose this coding, include a full operative report and a letter explaining what your urologist did and why, and the extra work of putting in the second stent.Keep in mind: Because this was not a bilateral stent, modifier 50 (Bilateral procedure) is not appropriate.