52204 is for biopsy and 52332 is for stent removal. Per coding guidelines 52204 bundles with 52332 and modifier is allowed to unbundle. By the description it would seem that these two procedures are separate and distinct. Is it being assumed that while removing the stent the biopsy would be incidental? What would unbundle these two procedures? Documentation:
After the patient was identified, consent was obtained. The patient was taken to the operating room and induced under general anesthetic followed by conversion to the low lithotomy position. A timeout was performed. A 23 French cystoscope was inserted into the urethra and advanced into the bladder. The aforementioned findings were noted in the bladder. The prior left stent was grasped and withdrawn to urethral meatus. A 0.038 Bentson guidewire was advanced through this and the stent removed. A 5 French open-ended catheter was inserted and advanced to the renal pelvis. Contrast was instilled ensuring that the wire was in the collecting system noting the aforementioned findings. Representative images saved. The wire was replaced and a 7 fr x 24 cm double J ureteral stent placed with the proximal coil curling in the renal pelvis and the distal coil in the bladder. The string was removed. The nodule at the dome was then biopsied with cold-cup biopsy forceps. I performed the entirety of the operation for which we were involved
After the patient was identified, consent was obtained. The patient was taken to the operating room and induced under general anesthetic followed by conversion to the low lithotomy position. A timeout was performed. A 23 French cystoscope was inserted into the urethra and advanced into the bladder. The aforementioned findings were noted in the bladder. The prior left stent was grasped and withdrawn to urethral meatus. A 0.038 Bentson guidewire was advanced through this and the stent removed. A 5 French open-ended catheter was inserted and advanced to the renal pelvis. Contrast was instilled ensuring that the wire was in the collecting system noting the aforementioned findings. Representative images saved. The wire was replaced and a 7 fr x 24 cm double J ureteral stent placed with the proximal coil curling in the renal pelvis and the distal coil in the bladder. The string was removed. The nodule at the dome was then biopsied with cold-cup biopsy forceps. I performed the entirety of the operation for which we were involved