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Urology Coding Alert

Reader Question:

Add 52 If The Physician Skips Cystourethroscopy

Question: My doctor did a looposcopy with lithotripsy and stone removal. What is the proper coding for this procedure? Maryland Subscriber Answer: First, report CPT 52318 (Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large [over 2.5 cm]) for the lithotripsy and stone removal. Append modifier 52 (Reduced services) because the physician did not perform the cystourethroscopy. Second, report 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the looposcopy performed in place of the cystoscopy. You should use 52318, a bladder procedure code, because the ileal loop acts as a substitute bladder, and the lithotripsy involves a complicated calculus formed on a foreign body (i.e. the intestinal mucus), which is seen frequently in an ileal diversion. The diagnosis code you use with 52318 should be bladder calculus (594.1). The diagnosis code [...]

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