Wiki Cystourethroscopy Lithotripsy stent insertion on right side and DJ stent removal on Left Side

[sharanyach]

Dear Team,
Can we code CPT - 52356 right and CPT - 52310 Left on same day by same physician. There is NCCI edits but I have doubt as it is different Laterality and 3M also in leading giving both codes??

 

[thomas7331]

52310 cannot be unbundled from 52356 due to the 'separate procedure' designation in CPT. Even with a modifier, and even if performed on the contralateral side or at a separate encounter, this code will always be denied by payers that follow NCCI.

 

[KaylaRieken]

I agree with Thomas.

 

[liqgold2@aol.com]

Although I agree with the above, I would also bill for the service since we are dealing with two stents, extra work, and not the removal and replacement of one stent. I would suggest the following coding for your clinical scenario:
52356-RT, and
52310-LT or XS.
Most likely the 52310 will be denied, but I would appeal with the above remarks. Also remember that carriers are now paying in an above similar example if a new stent is placed in the second side instead of a removal where this scenario was once denied.