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stone procedures

M

Miko24

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120
Location
Phelps, WI
I have a doctor that states you can charge the 52356 for lasering stone in the right kidney and 52352 for basketing a separate ureter stone. Bundling issues?

52356-RT
52352-59,RT
 
You can.
I would suggest the following coding for your clinical scenario:
52356-RT for the renal stone, dx. N20.0
52332-XS-RT for the stone in the epsilateral ureter, dx. N20.1, considered by the AUA and CPT as a stone in a separate structure, hence the use of modifier-XS
 
CX123 said:
I have a doctor that states you can charge the 52356 for lasering stone in the right kidney and 52352 for basketing a separate ureter stone. Bundling issues?

52356-RT
52352-59,RT
Click to expand...
This question comes up here on the forum periodically and there doesn't seem to be a consensus on the correct answer. Although CPT may state that the second procedure may be reported separately, the NCCI guidance is clear that stone procedures may only be reported once per side, not per calculus. From the NCCI Policy Manual, Chapter 7, Section H.3:

The UOS for a procedure describing destruction or removal of renal system calculus(i) is one. The unit of service is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, the CPT code may be reported with modifier 50 and one unit of service.
 
thomas7331 said:
This question comes up here on the forum periodically and there doesn't seem to be a consensus on the correct answer. Although CPT may state that the second procedure may be reported separately, the NCCI guidance is clear that stone procedures may only be reported once per side, not per calculus. From the NCCI Policy Manual, Chapter 7, Section H.3:

The UOS for a procedure describing destruction or removal of renal system calculus(i) is one. The unit of service is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, the CPT code may be reported with modifier 50 and one unit of service.
Click to expand...
Looking at the NCCI Policy Manual, Chapter 7, Section H.3 it only gives the example for a ureter calculus. Below is from the Manual -

"For example, CPT code 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)) shall be reported with only one unit of service per ureter regardless of the number of calculi in the ureter. If the procedure is performed on bilateral ureters, it may be reported with modifier 50 and one unit of service. This code shall not be reported with a separate unit of service for each calculus."

Does anyone have any feedback on how to get a kidney stone and ureter stone paid when done with the same set of codes as the example above?
52356-RT
52352 -59,RT
 
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