CPT code for ureteroscopy with laser lithotripsy

CPT Code For Ureteroscopy With Laser Lithotripsy (2022) Description, Guidelines, Modifiers & Examples

CPT code for ureteroscopy with laser lithotripsy is coded as 52353. Cystourethroscopy, with ureteroscopy or pyeloscopy, with lithotripsy (ureteral catheterization is included), includes the fragmenting of the stone with laser lithotripsy through the ureteroscopy as well as the ureteral catheterization.

Summary

Suppose a cystourethroscopy without ureteroscopy is performed with lithotripsy to fragment ureteral stones. In that case, use CPT code for ureteroscopy with laser lithotripsy 52353, cystourethroscopy, including ureteral catheterization, with the fragmentation of ureteral calculus (e.g., ultrasonic or electro-hydraulic technique), should be reported.

Ureteroscopy with laser lithotripsy breaks up kidney stones that have not passed and remain lodged in the ureter. During the procedure, a laser beam is applied to the stone to break it into small pieces and allow it to pass easily.

Calculus is an abnormal, stone-like concretion of calcium, cholesterol, mineral salts, or other substances that form in any part of the body.

Use or insert a tubular device into a duct, hollow organ, blood vessel, or body cavity for withdrawing fluids or injecting for diagnostic or therapeutic purposes.

Hematuria: Blood in the urine may be visible, or the presence of red blood cells may be visible only under a microscope.

Hydronephrosis: Distension of the kidney is caused by an accumulation of urine that cannot flow out due to an obstruction caused by conditions such as kidney stones or vesicoureteral reflux.

Hydroureter: abnormal enlargement or distension of the ureter with water or urine caused by an obstruction.

Lithotripsy: Destruction of calcified substances in the gallbladder or urinary system by smashing the concretions into small particles to be washed out. This procedure may be done by surgical or noninvasive methods, such as ultrasound.

CPT Code For Ureteroscopy With Laser Lithotripsy Description

The physician examines the urinary collecting system with endoscopes passed through the urethra into the bladder (cystourethroscopy), ureter (ureteroscope), and renal pelvis (pyeloscope) and removes or manipulates a stone (calculus).

To extract or manipulate a calculus, the physician passes the appropriate surgical instruments through an endoscope to perform the procedure. Then, a ureteral catheter is inserted, and the endoscope and instruments are removed.

cpt code for ureteroscopy with holmium laser lithotripsy

CPT Code For Ureteroscopy With Laser Lithotripsy Coding Guidelines

Report 52352 if the physician passes a stone basket through an endoscope to extract or manipulate a calculus. Report CPT code for ureteroscopy with laser lithotripsy 52353 if the physician uses an ultrasonic, electrohydraulic, or laser technique to fragment the calculus. 

Surgical cystourethroscopy always includes a diagnostic cystourethroscopy. Do not report 52353 with 52332 or 52356 when performed together on the same side.

Insertion and removal of a temporary stent are included in these procedures. For insertion of a self-retaining, indwelling stent performed during cystourethroscopic procedures, report 52332 in addition to the primary procedure performed and appended modifier 51.

Cystourethroscopy, with ureteroscopy or pyeloscopy, with lithotripsy (ureteral catheterization is included), should be reported with only one unit of service per ureter despite the number of calculi in the ureter.

If the procedure is done on both ureters, it may be reported with modifier 50 and one UOS. This code should not be reported with a separate UOS for each calculus.

Cystourethroscopy and transurethral procedures include fluoroscopy when performed. Therefore, CPT codes describing fluoroscopy or fluoroscopic guidance (e.g., 76000, 77002) should not be reported separately with a cystourethroscopy or transurethral procedure CPT code.

Related Procedures For CPT Code For Ureteroscopy With Laser Lithotripsy

52351 Cystourethroscopy with ureteroscopy or pyeloscopy, diagnostic.

52352 Cystourethroscopy, with ureteroscopy or pyeloscopy, removal or manipulation of calculus (ureteral catheterization is included).

52354 Cystourethroscopy, with ureteroscopy or pyeloscopy, biopsy or fulguration of ureteral or renal pelvic lesion 52355 Cystourethroscopy, with ureteroscopy or pyeloscopy, with resection of ureteral or renal pelvic tumors 52356 Cystourethroscopy, ureteroscopy or pyeloscopy, with lithotripsy, including insertion of an indwelling ureteral stent (e.g., Gibbons or double-J type),

Therapeutic cystourethroscopy always includes diagnostic cystourethroscopy. To report a diagnostic cystourethroscopy, use this form (52000). Therapeutic cystourethroscopy with ureteroscopy or pyeloscopy always includes diagnostic cystourethroscopy with ureteroscopy or pyeloscopy.

  • To report a diagnostic cystourethroscopy with ureteroscopy or pyeloscopy, use 52351.
  • Do not report 52000 in conjunction with 52320, 52343, and 52356.
  • Do not use 52351 with 52344-52346 or 52352-52356.

The insertion & removal of a temporary ureteral catheter (52005) during diagnostic or therapeutic cystourethroscopy with ureteroscopy or pyeloscopy is included in 52320-52356 and should not be reported.

To code for insertion of a self-retaining, indwelling stent performed during diagnostic or therapeutic cystourethroscopy with ureteroscopy or pyeloscopy, report 52332, in addition to the primary procedure(s) performed (52320-52330, 52334-52352, 52354, 52355), and append modifier 51.

CPT 52332 is used to report a unilateral procedure unless otherwise specified.

For bilateral insertion of indwelling ureteral stents, self-retaining use code 52332 and append modifier 50. To code for cystourethroscopic removal of a self-retaining, indwelling ureteral stent, see 52310, 52315, and append modifier 58, if appropriate.

The following ICD-10-CM Diagnostic Codes are commonly used with CPT Ureteroscopy with Laser Lithotripsy.

  • N13.2: Hydronephrosis with renal and ureteral calculous obstruction
  • N20.0: Calculus of the kidney
  • N20.1: Calculus of the ureter
  • N20.2: Calculus of the kidney with calculus of the ureter
  • N21.0: Calculus in bladder
  • N21.1: Calculus in the urethra.
  • N21.8: Other lower urinary tract calculus

CPT Code For Ureteroscopy With Laser Lithotripsy Modifiers

The CPT for diagnostic laparotomy has a global period of 90 days. 

The following are common modifiers:

Modifier 22 is used when the procedure takes longer than normal procedural services.

Modifier 47 is used when the physician gives anesthesia to the patient that is not normally required.

Modifier 51 is used when multiple procedures are performed at a time.

In some circumstances, modifier 52 is used when some circumstances’ procedure is partially reduced.

Modifier 53 is used when the surgical or diagnostic procedure is discontinued after starting the procedure due to some circumstances.

When this procedure is performed in a global period, modifier 58 is used. It may be staged or related to a procedure or service by the same physician or other QHC professionals during the postoperative period.

Modifier 59 is used when other distinct procedural services are performed other than E/M.

Modifier 78 is used when a patient has an unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the postoperative period. 

Modifier 79 is used when a patient has an unrelated procedure or service by the same physician or another QHC professional during the postoperative period.

Other than these modifiers, 23, 54, 55, 56, 58, 62, 63, 76, 77, 80, 82, 81, 99, AI, AQ, AR, AS, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, GY, and modifier GZ is also used with Ureteroscopy with Laser Lithotripsy.

CPT Code For Ureteroscopy With Laser Lithotripsy Examples

The following are examples of when the CPT code for ureteroscopy with laser lithotripsy may be used.

Examples 1

A patient with an indwelling stent requires removal and replacement of a ureter stent using cystoscopy. The previously placed stent was removed, and a new stent was inserted.

CPT 52332 should be billed when removing a ureteral stent and replacing it with a new stent on the same side.

Examples 2

A patient was diagnosed with a 4 mm stone in the upper ureter. The patient is scheduled for ureteroscopy with lithotripsy of the stone. During the same session, the urologist pushes the stone into the kidney (manipulating the calculus before using lithotripsy to break up the stone).

CPT code for ureteroscopy with laser lithotripsy 52353 since the two procedures were performed on the same stone. Therefore, it would not be appropriate to append a 59 or any X modifiers.

Examples 3

A 3 mm stone in the upper pole of the left kidney and a 4 mm stone in the left kidney’s lower pole were both manipulated into the renal pelvis and treated with ureteroscopy with lithotripsy.

CPT code for ureteroscopy with laser lithotripsy 52353 These are two separate stones in the same structure (organ) treated by the same operative technique. This would not be considered an appropriate circumstance to code the treatment of each stone according to the AU.

Examples 4

Both stones were treated with ureteroscopy with lithotripsy, with a 3 mm stone in the upper pole of the left kidney, including a 4 mm stone in the left ureter.

52353-XS (-59 for private payers) Two separate stones in separate “organs” of the urinary tract.

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