I need some help. I have a ASC case where the MD did a cystourethroscopy w/ bilaterial retrograde ureterograms. He also did Litholapaxy with the extraction of stones. Less than 2 grams of stones. Should I bill 52317 and 52005-50 or 52310?
without seeing the op note and based strictly on what you have posted, I think that the 52353 is more appropriate. The 52005 bundles. Also since you are an ASC, you can capture the 74420-TC for the retrograde pyleograms.
His urethra was entered with the #21 - Wolf cystourethroscope. The urethra was normal to the external sphincter. The prostatic urethra showed only minimal enlargement and was less than 2 grams of obstructing tissue present noted. The bladder was entered and there were multiple stones in the bladder. Using the rigid biopsy forceps, one of the stones is broken up into multiple pieces and these pieces were removed. Several smaller pieces were also removed of other stones. After this was completed there were no further stones noted in the bladder. Bilaterial retrograde ureterograms were performed. There were felt to be within normal limites. Using both the 30 and the 70 - degree kenses, I carefully inspected the bladder. There were no obvious bladder tumors of mucodal lesions noted. At the sompletion of the procedure, the bladder was drained. The retrograde that had been performed were reviewed and these were felt to be within normal limits. The cystoscope was then removed.
Coders Desk Reference 2010
The Physician examines the urinary collecting system with endoscopes passecd through the urethra into the bladder (Cystourethroscope) ureter (Ureteroscope) and renal pelvis (pyeloscope) and removes or manipulates a stone (calculus) To extract or manipulate a calculus the physician passes a stone basket through an endoscope the Physician inserts a ureteral catheter and removes the endoscopes. Report 52352 if the physician passes a stone basket through an endoscope to extract or manipulate a claculus. Report 52353 if the physician passes an electro hydraulic lithotriptor probe through an endoscope to pulverize a calculus.