52353 CPT Code For Ureteroscopy With Laser Lithotripsy (2023) | Description, Guidelines & Examples

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

Summary

If a cystourethroscopy without ureteroscopy is performed with lithotripsy to fragment ureteral stones, the CPT code for ureteroscopy with laser lithotripsy (CPT 52353) 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 quickly.

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

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. Surgical or noninvasive methods, such as ultrasound, may do this procedure.

Description Of The CPT Code For Ureteroscopy With Laser Lithotripsy

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.

The official description of CPT 52353 is: “Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included).”

Billing 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 guidance (e.g., 76000, 77002) should not be reported separately with a cystourethroscopy or transurethral procedure CPT code.

Billing Related Ureteroscopy Procedures

The following procedures are related to CPT code 52353:

• CPT 52351: “Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic.”
• CPT 52352: “Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included).”
• CPT 52354: “Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion.”
• CPT 52356: “Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, 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, use code 52332 and append modifier 50 for self-retaining. 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.

• ICD 10 CM N13.2: Hydronephrosis with renal and ureteral calculous obstruction
• ICD 10 CM N20.0: Calculus of the kidney
• ICD 10 CM N20.1: Calculus of the ureter
• ICD 10 CM N20.2: Calculus of the kidney with calculus of the ureter
• ICD 10 CM N21.0: Calculus in bladder
• ICD 10 CM N21.1: Calculus in the urethra.
• ICD 10 CM N21.8: Other lower urinary tract calculus

Billing Examples

The following are examples of when the 52353 CPT code for ureteroscopy with laser lithotripsy may be used.

Examples 1

A patient with an indwelling stent requires the 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 52353 was reported 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

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.

Billing will be: 52353-XS (-59 for private payers)—two separate stones in separate “organs” of the urinary tract.