left Semi-rigid ureteroscopy and stone extraction of left ureteral stone and Left flexible pyeloscopy with stone extraction of left renal stone

carol52

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Hello I have a question about the removal of both stones on the same side ( LEFT) the ureteral stone was removed with semi-rigid ureteroscopy and the other left stone was a renal stone
removed with a flexible pyeloscopy both with basket retrieval with a cystoscopy placement of a ureteral stent.
Can both stones be billed for when 2 different scopes are used.

This patient had already had a recently underwent a ESWL with stent placement and postoperatively she developed STEINSTRASSE ( column of stone fragments that form and block the Ureter).
So Dr. was removing the stone fragments from the previous ESWL
Thanks,
Carol
 

thomas7331

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The NCCI guidelines specify that the unit of coding for these procedure is per side, not per stone or per scope, so multiple units and/or modifiers to unbundle secondary codes may only be used when the additional procedure is done on the contralateral ureter or kidney.
 

thomas7331

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Thomas , we have had this conversation before and the Dr. and coding manager are still insisting that this is appropriate. This is what was sent to me...
View attachment 5249
OK, yes, I recall the question but didn't realize it was the same person asking. You're going to run into one of two problems in these scenarios - either you're going to exceed the MUE for your code (if you're trying to bill the same CPT twice on the same side, in which case your second procedure will deny; or, you're going to hit a bundling edit (if you're billing an incidental code) and will need to override it with a modifier indicating that it's a separate procedure. If your payer follows NCCI (which I'll admit that not all payers do), then the NCCI manual clearly states (in my reading of it) that in these situations the unbundling modifier is only to be used for contralateral procedures.

I'm not sure what else you can do to convince the managers or providers other than request an independent opinion or get something in writing from the payer or Coding Clinic, for example. But ultimately it's up to your employer to make the call on something like this, so if they insist, just be sure that you've documented your conversations so that you're covered in the event it might ever turn into a problem.
 

liqgold2@aol.com

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When you review this case scenario clinically it appears that the stone in the ureter was from a fragmnet of the renal stone that was fragmented by ESWL. that then passed into the ureter. The renal stone appears to be a remnant of the renal stone not completely fragmented by ESWL. Cosidering these facts I would suggest the following coding for your second clinical scenario:
52352 -58 for the staged removal of the remaining renal stone, in the 90 day global of the ESWL,
52352-78-XS for the ureteral stone a treatment of a complcation of the ESWL in a different organ, the ureter,
add 52332 if another stent was placed.
It is true that the second 52352 may not be paid, but it was a stone in adifferent noted organ with the XS modifier. If anyone would like to discuss this coding wirh me, please call me at 516-741-0118, I would be happy to help you.
 
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