Top 5 Urology Times coding articles of 2025

Coding for the treatment of kidney stones appears to be of high interest to urologists, as evidenced by our top-read Coding Q&A columns from 2025. Written by experts Jonathan Rubenstein, MD, and Mark Painter, other highlights from this year include guidance on vasectomy coding as well as the proposed rule for the Calendar Year 2026 Medicare Physician Fee Schedule (MPFS).

Medicare proposed rule for 2026: CMS, what are you doing to us?

Rubenstein and Painter’s annual analysis of the MPFS was well read (their breakdown of the final rule can be found here). In the column, they touched on topics including the conversion factor, telehealth, relative value unit adjustments, and more.

Coding Q&A: How to bill for second-generation stone device

“To answer the question about whether an additional Current Procedural Terminology code can be used for stone irrigation and aspiration, we need to consider the evolution of stone aspiration technology and the physician effort required to perform the service,” write Rubenstein and Painter.

Clarifying coding for percutaneous nephrolithotomy procedures

“Your review of the new codes 50436 and 50437 in April 2023 was very informative.¹ Do you know whether Medicare has changed the National Correct Coding Initiative (NCCI) edits to allow use of these codes with 50080 and 50081? Also, is retrograde ureteroscopy with lithotripsy for ureteral stone at the time of 50081 (on the same side) now allowed? Three months ago, I reported a 50081 and 52356 with 50437, and my hospital-based coders are only allowing me to submit a 50081 based on NCCI edits,” a reader asks.

Clarifying CPT 52353 billing for same-side stone cases

Reader question: “I am having a discussion with one of our urologists on coding for 2 stones on the same laterality. We read your publication ‘Update—Billing for Multiple Stones; August 20, 2018.’ CPT 52353 has a Medically Unlikely Edit (MUE) of 1 with an MUE Adjudication Indicator of 2. Can you please help us understand the rationale for Scenario #7 from your publication:

Scenario #7: A 3-mm stone in the upper pole of the left kidney and a 4-mm stone in the left ureter; both stones were treated with ureteroscopy and lithotripsy.

Answer #7: Two separate stones in ‘separate organs’ of the urinary tract.

Correct coding: 52353 and 52353-XS (-59 for private payers)”

Level of service for vasectomy prompts coding confusion

Reader question: “Our group has been reporting a level 3 new (99203) or established (99213) evaluation and management (E/M) code for visits for patients considering a vasectomy. Recently, some payers have been down-coding these visits to level 2 or sometimes even denying these codes altogether! What is the correct level of service for a vasectomy consultation visit?”

REFERENCE

1. Rubenstein J, Painter M. Clearing up confusion surrounding percutaneous nephrolithotomy coding. Urology Times. April 20, 2023. Accessed December 12, 2025. https://www.urologytimes.com/view/clearing-up-confusion-surrounding-percutaneous-nephrolithotomy-coding

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

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.