kjburns6409
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Hello, I have a urology provider that wants to bill separately for basketing of stone (52352) done during lithotripsy with stent placement (52356). NCCI edits do bundle 52352 with 52356 so, this seems like a common sense answer if it's the same stone on the same side, that it's bundled. However, I have read previously that basketing of the stone is not included and to use a modifier -59 so I'm second guessing. Below is from a sample note.
Preop diagnosis: Left nephrolithiasis
Postop diagnosis: Same
Procedure: Cystoscopy, left flexible ureteroscopy, laser lithotripsy, basket of stone, and ureteral stent placement
Anesthesia: General
Estimated blood loss: 2 ml's
Blood replacement products: None
Findings: Left proximal ureteral calculi
Specimen: Stone
Drains: None
Complications: None
Disposition: PACU in stable condition
Indication: female who presented with left ureteral calculi. She completed cystoscopy with emergent left ureteral stent placement. The patient was explained risks, benefits, and alternatives; then signed informed consent. Patient went to the operating room a supine position and received anesthesia. The patient received preoperative antibiotics.
Description of Procedure: The patient was placed in dorsal lithotomy position and cleaned and prepped in a sterile fashion. A cystoscope was placed atraumatically into the bladder through the urethra. The left ureteral stent was grasped with forceps and brought to the meatus. A hyper wire was placed through the stent and into the left collecting system, confirmed with fluoroscopy. The existing ureteral stent was removed. I then placed a dual-lumen ureteral sheath and a stiff wire into the left collecting system. A ureteral access sheath was placed over the stiff wire into the left collecting system.
A flexible ureteroscope was then placed into the left ureter and the proximal ureter definitely had edema and irritation from the stone. I then advanced the ureteroscope into the renal pelvis and performed pan-pyeloscopy which demonstrated the stone to advanced into the upper pole of the kidney. Using a 200 micron laser fiber I performed laser lithotripsy until the stone was fragmented. I then removed the stone fragments with basket and sent for specimen. The ureteroscope was removed.
A cystoscope was then replaced into the bladder and over the wire a 6 French x 26 cm ureteral stent was placed into the left collecting system. Fluoroscopy demonstrated good position in the kidney and I visualized the curl in the bladder. The bladder was drained and the cystoscope removed.
The patient will follow-up in Urology Clinic 10 days for cystoscopy with ureteral stent removal
Preop diagnosis: Left nephrolithiasis
Postop diagnosis: Same
Procedure: Cystoscopy, left flexible ureteroscopy, laser lithotripsy, basket of stone, and ureteral stent placement
Anesthesia: General
Estimated blood loss: 2 ml's
Blood replacement products: None
Findings: Left proximal ureteral calculi
Specimen: Stone
Drains: None
Complications: None
Disposition: PACU in stable condition
Indication: female who presented with left ureteral calculi. She completed cystoscopy with emergent left ureteral stent placement. The patient was explained risks, benefits, and alternatives; then signed informed consent. Patient went to the operating room a supine position and received anesthesia. The patient received preoperative antibiotics.
Description of Procedure: The patient was placed in dorsal lithotomy position and cleaned and prepped in a sterile fashion. A cystoscope was placed atraumatically into the bladder through the urethra. The left ureteral stent was grasped with forceps and brought to the meatus. A hyper wire was placed through the stent and into the left collecting system, confirmed with fluoroscopy. The existing ureteral stent was removed. I then placed a dual-lumen ureteral sheath and a stiff wire into the left collecting system. A ureteral access sheath was placed over the stiff wire into the left collecting system.
A flexible ureteroscope was then placed into the left ureter and the proximal ureter definitely had edema and irritation from the stone. I then advanced the ureteroscope into the renal pelvis and performed pan-pyeloscopy which demonstrated the stone to advanced into the upper pole of the kidney. Using a 200 micron laser fiber I performed laser lithotripsy until the stone was fragmented. I then removed the stone fragments with basket and sent for specimen. The ureteroscope was removed.
A cystoscope was then replaced into the bladder and over the wire a 6 French x 26 cm ureteral stent was placed into the left collecting system. Fluoroscopy demonstrated good position in the kidney and I visualized the curl in the bladder. The bladder was drained and the cystoscope removed.
The patient will follow-up in Urology Clinic 10 days for cystoscopy with ureteral stent removal
