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How to bill for stone removal when stone is no longer present at time of procedure

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"Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service," writes Jonathan Rubenstein, MD, and Mark Painter.

Could you tell me what the appropriate diagnosis would be when a patient goes in for surgery to have a ureteral stone (52351 and 52332) removed and a stent placed and the stone is no longer present, presumably it has already passed?

Jonathan Rubenstein, MD

Jonathan Rubenstein, MD

Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service. The service performed is an HCPCS [Healthcare Common Procedure Coding System] code, either Level I or Level II. The accompanying reason is chosen from the International Classification of Diseases 10th Revision With Clinical Modification (ICD-10-CM).

In the situation described, a patient is brought to a procedure room to perform what is scheduled as a removal of a ureteral stone and a stent placed, which encompasses 52352 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with

Mark Painter

Mark Painter

removal or manipulation of calculus [ureteral catheterization is included]) and 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [eg, Gibbons or double-J type])or similarly for laser lithotripsy and stent placement, 52356 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [eg, Gibbons or double-J type]) for the indication of N20.1 stone, ureter.

However, upon performance of the case, the patient was found to have passed the stone and the patient had undergone a diagnostic ureteroscopy and stent placement (CPT codes 52351, cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic and 52332, respectively). Assuming there was no other pathology found and no stone found but the patient was treated with a stent, the indication for the procedure remained unchanged. Therefore, ICD-10-CM code N20.1 should still be chosen per ICD-10 guidelines, which indicate in the absence of another, more appropriate diagnosis, the intended reason for the service should be reported even if the condition no longer presents.

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.

Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

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