Urology Coding Alert

Question: Should I report 52352 for "breaking up of a renal stone in the kidney using a laser" when the urologist uses a flexible ureteroscope?


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Answer: Actually, you should use CPT 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) for this procedure. Because your physician indicated that he used a laser to break up the stone, 52353 is more appropriate than CPT 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]).  

Typically, you'll report 52352 if the urologist uses a stone basket to extract or remove the calculus.

Tip: If the urologist also inserts and removes a temporary ureteral catheter (often erroneously called a stent) during the cystourethroscopy procedure, you should not report the stent/ureteral catheter procedure separately, because carriers consider this temporary stent part of the cystourethroscopy work. If your physician inserts a self-retaining indwelling stent, report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) in addition to the primary procedure code.

Append modifier 59 (Distinct procedural service) to 52332 to break the bundle between 52353 and 52332. For some private payers, you may also need to add modifier 51 (Multiple procedures) to 52332 to indicate that your physician performed more than one procedure.