Urology Coding Alert

Question: A patient with bilateral ureter stones underwent a cystoscopy and bilateral placement of double-J stents. The urologist then performed an extracorporeal shock wave lithotripsy of the right and left ureteral stones. What’s the CPT^® coding?

Texas Subscriber

Answer: Since there’s no existing code that combines each of the aforementioned services, your coding breakdown should include two codes: one for the cystoscopy with bilateral stent placement and another for the bilateral extracorporeal shock wave lithotripsy.

For the lithotripsy, you should look to code 50590 (Lithotripsy, extracorporeal shock wave). Attach modifier 50 (Bilateral procedure) to 50590 since the urologist performed the lithotripsy on both the left and right ureters.

For the cystourethroscopy and bilateral stent placement, report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)) with modifier 50.

These codes have no existing National Correct Coding Initiative (NCCI) edits, so determining the code order is your last point of consideration. Report the code with the higher relative value units (RVUs) first: 50590 based on the 2020 Medicare Physician Fee Schedule.