RainyDaze
Networker
I have a question regarding the new code for lithotripsy and stent placement. Sometimes our docs will perform the lithotripsy and then use a basket to extract the fragments. The codes 52353 and 52352 use to bundle, so I could only code with 52353. But now with the new code of 52356, it is not bundling with 52352. We have a difference of opinion in our office, whether to code with just 52356, or to code with both 52356 and 52352.
Any help is appreciated!
Lori
Here is an example:
POSTOPERATIVE DIAGNOSIS: 7 mm Left distal ureteral stone.
PROCEDURE PERFORMED: Cystoscopy, left ureteroscopy, laser lithotripsy, stone basket, retrograde pyelogram, and 6 x 26 double-J stent placement.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative area by name and date of birth. Again, the procedure was reviewed, and he agrees to proceed. Radiologic images were reviewed, and this is a left-sided stone. He received IV antibiotics prior to starting the procedure. He was brought to the operating room, placed in the supine position. He had Venodynes for DVT prophylaxis. Anesthesia was induced. He was then placed in lithotomy and prepped and draped in a general sterile fashion. Cystoscopy was performed, and the left ureteral orifice was identified in its usual anatomic position, and a wire was advanced up to the kidney under fluoroscopic vision. A radiopaque stone was noted in the distal ureter. Next, a rigid ureteroscope was used, and with the help of a second wire, the ureter was entered. The stone was located. It was lasered into small fragments, which were all basketed and sent for analysis. Next, the mid ureter and distal ureter were inspected, and no fragments were remaining. We performed a retrograde pyelogram for the proximal ureter and upper collecting system, which was unremarkable. We placed a 6 x 26 double-J stent at the end of the procedure, which was left to a string. The bladder was emptied, and all stone fragments were removed and sent for analysis. The patient tolerated the procedure well. There were no complications. He was extubated and taken in stable condition to the recovery room. He will follow up in the office on Monday for stent removal.
Any help is appreciated!
Lori
Here is an example:
POSTOPERATIVE DIAGNOSIS: 7 mm Left distal ureteral stone.
PROCEDURE PERFORMED: Cystoscopy, left ureteroscopy, laser lithotripsy, stone basket, retrograde pyelogram, and 6 x 26 double-J stent placement.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative area by name and date of birth. Again, the procedure was reviewed, and he agrees to proceed. Radiologic images were reviewed, and this is a left-sided stone. He received IV antibiotics prior to starting the procedure. He was brought to the operating room, placed in the supine position. He had Venodynes for DVT prophylaxis. Anesthesia was induced. He was then placed in lithotomy and prepped and draped in a general sterile fashion. Cystoscopy was performed, and the left ureteral orifice was identified in its usual anatomic position, and a wire was advanced up to the kidney under fluoroscopic vision. A radiopaque stone was noted in the distal ureter. Next, a rigid ureteroscope was used, and with the help of a second wire, the ureter was entered. The stone was located. It was lasered into small fragments, which were all basketed and sent for analysis. Next, the mid ureter and distal ureter were inspected, and no fragments were remaining. We performed a retrograde pyelogram for the proximal ureter and upper collecting system, which was unremarkable. We placed a 6 x 26 double-J stent at the end of the procedure, which was left to a string. The bladder was emptied, and all stone fragments were removed and sent for analysis. The patient tolerated the procedure well. There were no complications. He was extubated and taken in stable condition to the recovery room. He will follow up in the office on Monday for stent removal.
