Urology Coding Alert

Question: A patient had an ESWL and then came back for stent removal. The urologist found multiple stone fragments in the ureters, and therefore performed a ureteroscopic examination and stone extraction. Can I report both the ureteroscopy and the stent removal?

Tennessee Subscriber

Answer: You cannot report both the ureteroscopy and stent removal. The stent removal codes (52310, Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder; simple and 52315, ... complicated) are both bundled into the ureteroscopic stone extraction code, according to the National Correct Coding Initiative. You cannot unbundle these codes using any sort of modifier.
 
You should report 52352 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is include]]) for the ureteroscopy and stone extraction.
 
If the urologist then replaced the stent, you can also report CPT 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]).
 
Append modifier 59 (Distinct procedural service) or modifier 51 (Multiple procedures) as appropriate to indicate that your physician performed more than one procedure during the same operative session. You need modifier 59 to unbundle the National Correct Coding Initiative edits on these two codes.