Wiki 51705 Denial


Brooklyn, MI
Best answers
I have a Medicare denial for CPT 51705 as inclusive to 52356. I don't see that there are any edits for these codes. The procedure was performed through the same incision. The op report reads:

"Once appropriate time-out had been performed with all parties consenting the procedure a flexible cystoscope was inserted through the urethra into bladder. The previously placed stent was visualized in the Left ureteral orifice.* A grasper was used to pull the stent to the urethral meatus.* A Glidewire was then inserted through the stent and visualized in the renal pelvis under fluoroscopy.* The stent was removed.* The ureter was then dilated and a 2nd wire was placed as a safety wire.* A ureteral access sheath was then inserted.* A flexible ureteroscope was then inserted through the access sheath into the renal pelvis.* The stone was localized in the upper pole.* A 200 micron holmium laser fiber was inserted and used to fragment the stone into several pieces.* These pieces were basketed and sent for analysis.* At this point a thorough and complete pyeloscopy was performed there are no additional stones present.* Several amorphous collections of material were also removed.* At this point the ureteral access sheath was backed out with the scope in place for complete visualization of the ureter.* There were no additional stones visualized.* A 6 x 22 French stent was then inserted over the wire and visualized with good curl in the renal pelvis as well as the bladder under fluoroscopy.* The cystoscope was replaced and a curl was visualized.* At this point the suprapubic tube was exchanged under direct visualization with the cystoscope.* Scope was then removed."
51705 is for removal of SP tube not a ureteral stent
Cysto ureteral stent removal is 52310 and is bundled (not allowed) when replacing a stent. 52356 is for both Lithotripsy and ureteral stent.

Therefore, the insurance denial is correct.