Correct CPT and ICD-10 Coding of Urinary Stone Procedures

The treatment of urinary stone disease is an everyday event for most urological practices. Recent changes in diagnoses with the new ICD-10 code set, new treatment clinical scenarios and changes in billing polices for both Medicare and commercial carriers make coding for these services confusing to many new and experienced coders. If an Urologists billed out a 52318 for a litholopaxy, the operative report will read it, as there are approximately seven to eight stones total. Most stones measure approximately 1.5 to 2 cm in size and maximum dimension. The remainder of the bladder appears normal. When questioning physicians about billing 52317, rather than 52318, a typical answer would be: “it is always based on overall or total stone burden”.

Treating several 2-cm stones to equal a total stone burden of 6 cm is different and requires more work, OR more time, than treating a single stone of 2 cm. Any reference stating measurement is based on the single largest stone, a reference to percutaneous nephrolithotomy codes 50080 and 50081. As-well-as if you treat multiple 2-cm stones in the kidney, that would be billed as 50081, as total stone burden is over 2.5 cm.

The codes identified would be:

  • 52317 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (<2.5 cm)
  • 52318 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (>2.5 cm)

As the codes include an “or” statement after the semicolon, we can treat the descriptions of each service as only looking at “simple” or “complex” and ignore the reference to size. In this approach, the physician interpretation and documentation determines whether the service provided was complex due to multiple stones, anatomy, or other complicating factor or whether the procedure was simple regardless of number of stones or anatomy. I believe this is the case for your example, and 52318 would be appropriate.

However, if the codes did not have the “or” in the descriptions and you only had the option to choose the correct code relative to size of stone—either small (<2.5 cm) or large (>2.5 cm)—our answer would be different. In other words, CPT® has indicated that the size of the largest stone should drive code selection for codes 50080 or 50081.

For more on correct coding of Urinary stone treatment, join our Live Coding Event – Virtual Coding Bootcamp 2016 – the year’s biggest virtual boot camp on coding updates. This event, presented by renowned speaker Dr. Michael A. Ferragamo Jr., will cover the new rules in urology coding and a better understanding of these rules to allow for more accurate coding and avoid mistakes that may lead to an audit and subsequent loss of revenue. Tools and benefits received after attending this conference will include, coding tips and references to actual clinical scenarios to enhance education and learning the coding for these stone services.

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