New code 52356

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CCI for 52356: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent.

We have some confusion as to the codes incorporated by this new code.

...A 20-French scope was inserted, and urethra, prostate, and bladder were unremarkable with the 30- and 70-degree lenses. A 0.035 guidewire was passed up the right ureter under fluoro guidance. We passed a 10-12 French access sheath and through that passed an 8.3-French flexible scope under direct visual guidance. The scope was advanced into the collecting system. All calyces were inspected. We found the stone as exected which was picked up with the stone basket and moved to an upper pole calyx. A 260-micron laser fiber was used to apply holmium laser energy which thoroughly broke the stone into smaller pieces. Fragments were extracted with the basket. No significant basketable fragments remained at the end of the procedure. The scope was withdrawn, leaving behind the guidewire. A double pigtail stent with full-length urethral dangle was deployed under fluoroscopic guidance in good position. The patient tolerated the procedure well.

I can see the cysto, the ureteroscopy, the laser litho, and insertion of the stent. I believe the 52356 very much incorporates every aspect of this op.

Comments? Thank you.
 
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