How To Use CPT Code 52318

CPT 52318 describes the procedure of litholapaxy, which involves the crushing or fragmentation of a large or complicated calculus (stone) in the bladder and the subsequent removal of the fragments. This article will provide an overview of CPT code 52318, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when to use this code.

1. What is CPT Code 52318?

CPT 52318 is used to describe the procedure of litholapaxy, which involves the crushing or fragmentation of a large or complicated calculus (stone) in the bladder and the subsequent removal of the fragments. This code is specifically used when the stone is over 2.5 cm in size.

2. Official Description

The official description of CPT code 52318 is: ‘Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm).’ This code is used when the provider performs a complicated cystourethroscopy to inspect the interior of the bladder, urethra, prostatic urethra, and ureteric openings. The provider then localizes, crushes, and removes a large stone over 2.5 cm in size.

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. A well-lubricated flexible or rigid cystourethroscope is inserted through the external opening of the urethra.
3. The provider examines the urethra and bladder to localize the exact position of the stone.
4. An ultrasonic lithotripter or another lithotripter instrument is inserted through the cystourethroscope.
5. The provider uses the lithotripter to deliver shock waves to crush the stone.
6. Extra time may be required to break up the large stone, remove any lodged fragments, or address complications that may arise during the procedure.
7. Once the stone is broken, the provider irrigates the bladder to wash away the remaining fragments.
8. The provider uses the cystourethroscope to ensure the complete removal of the stone and then withdraws the scope.

4. Qualifying circumstances

CPT code 52318 is used for cases where the provider performs litholapaxy on a large or complicated calculus (stone) in the bladder. The stone must be over 2.5 cm in size. This procedure is typically performed when other methods of stone removal are not feasible or effective.

5. When to use CPT code 52318

CPT code 52318 should be used when the provider performs litholapaxy on a large or complicated calculus (stone) in the bladder that is over 2.5 cm in size. It should not be used for stones smaller than 2.5 cm, as a different code (CPT 52317) is appropriate for those cases.

6. Documentation requirements

To support a claim for CPT code 52318, the provider must document the following information:

• The patient’s diagnosis and the need for litholapaxy
• The size of the stone and its location in the bladder
• The specific instruments and techniques used during the procedure
• Any complications encountered and how they were addressed
• The duration of the procedure
• The complete removal of the stone and confirmation through the cystourethroscope
• The provider’s signature

7. Billing guidelines

When billing for CPT code 52318, ensure that the procedure meets the criteria for a large or complicated stone over 2.5 cm in size. It is important to note that this code should not be reported if CPT codes 52317 or other related codes have already been performed in the previous seven days. Additionally, consider the location of the testing when coding for this procedure, as it may affect how the services are reported.

8. Historical information

CPT code 52318 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs litholapaxy on a patient with a large bladder stone measuring 3 cm in size.
2. A complicated cystourethroscopy is performed to crush and remove a 2.8 cm bladder stone.
3. Litholapaxy is performed on a patient with a 2.6 cm bladder stone using an ultrasonic lithotripter.
4. A provider performs litholapaxy on a patient with a 3.5 cm bladder stone, encountering complications that require additional time and intervention.
5. A large bladder stone measuring 4 cm in size is successfully crushed and removed through litholapaxy.
6. A complicated litholapaxy procedure is performed on a patient with a 2.7 cm bladder stone, requiring the use of a rigid cystourethroscope.
7. A provider performs litholapaxy on a patient with a 2.9 cm bladder stone, ensuring complete removal through cystourethroscopy.
8. Litholapaxy is performed on a patient with a 3.2 cm bladder stone, with the procedure lasting longer than usual due to the complexity of the stone.
9. A provider successfully crushes and removes a 2.6 cm bladder stone through litholapaxy, achieving complete clearance.
10. A complicated cystourethroscopy is performed to crush and remove a 2.7 cm bladder stone, with the procedure requiring additional irrigation and fragment retrieval.