Removing the previously placed ureter stent presents a dilemma

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I was reading an article regarding different approaches to removing a previously placed ureteral stent and ran into a coding dilemma. One of our providers performed a percutaneous nephrolithotomy for a large kidney stone on a patient with a previously placed ureter stent. The provider grasped the upper end of the stent with forceps placed through the percutaneous nephroscope and removed the stent through the percutaneous sheath. Our vendor insists on charging for the Current Procedural Terminology (CPT) code 52310 in addition to Percutaneous Nephrolithotomy, but I’m not sure. Can you enlighten us?

You are correct in questioning the use of CPT code 52310 for this approach to remove a previously placed ureter stent. Code CPT 52310 (cystourethroscopy, with removal of foreign body, calculus or ureteral stent from the urethra or bladder [separate procedure]; simple) describes the removal of a ureteral stent graft from the urethra or bladder using a cystoscope to directly view and grasp the stent, foreign body, or stone. This is not the approach described in your question above, which indicates that the provider removed the stent directly from the kidney from the percutaneous approach. Therefore, CPT 52310 encoding in this situation would not be correct. CPT 52310 could be coded if the stent was removed by inserting a cystoscope into the bladder for stent removal, if it was not associated with another service.

Based on this discussion, one might also be tempted to bill code CPT 50561 (renal endoscopy by nephrostomy or established pyelostomy, with or without irrigation, instillation or ureteropyelography, out of radiological service; with removal of foreign body or stone) or CPT code 50580 (renal endoscopy by nephrotomy or pyelostomy, with or without irrigation, instillation or ureteropyelography, excluding the radiological service; with removal of foreign body or calculus) which, when used alone, would more precisely describe percutaneous stent removal by nephrostomy or nephrotomy using a nephroscope.

However, before choosing to report any of these 2 codes, it is important to check the National Correct Coding Initiative (NCCI) grouping checks for other services that were provided during the surgical session. For example, code CPT 50080 (percutaneous nephrostolithotomy or pyeloslitotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket extraction; up to 2 cm) and code CPT 50081 (percutaneous nephrostolithotomy or pyeloslitotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket removal; greater than 2cm) both include CPT code 50561, so they cannot be coded together if the procedures are performed on the same kidney unit. The modifier 50 or XU would be required if these codes were to be reported on the contralateral renal unit.

An additional consideration that will need to be taken into account for the procedures performed is the specific policy established for retrograde stent exchange, which only allows stent insertion to be signaled if a stent is removed during the same operative session. as insertion.1

Although no such policy is included to address an antegrade stent exchange, the physician’s documentation should clearly justify the separate effort required to remove the existing stent, as required for the use of modifier 59 or XS.

Reference

1. NCCI Policy Manual [1/1/21] Chapter VII Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems CPT CODES 50000-59999 for National Initiative Correct Coding Medicare Services Policy Manual, paragraph c : 19

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c / o Urology Times®, at [email protected]

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 of writing. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information complies with their specific rules.


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