Q&A Cystourethroscopy w/ stent

[louise]

Female patient comes in for BIL nephrolithiasis. Her left stones were treated ureteroscopically and her right stone was very large. It was treated with an ureteroscopic procedure. She comes in today for her second ureteroscopic procedure to remove the remaining stone fragments. Right ureteroscopy, laser lithotripsy and right ureteral stent exchange were performed. What CPT codes are reported for this service?

a. 52353-58, 52332-58
b. 52353, 52310, 52332
c. 52353, 52332-51
d. 52353-76, 52332-76

This is a copy of a question on my mock exam. (I hope I'm not getting in trouble for posting it here.) The correct answer is C. I picked A because I thought is was a staged procedure.
The note below 52332 says "Do not report 52332 in conjunction with ... 52353 .... when performed together on the same side." Isn't every answer breaking that rule?
Guidelines above on same page (pg 306) describes use of modifier 51 for use with 52332 when combine with other procedures.
It seems that these two rules are contradicting each other. Would you take a look at this for me. Thanks!

 

[Ruth Sheets]

This is Blitz question so I moved it here. I'm just getting to this now...and will be taking a look at how to change this so it makes sense. Check back soon!

 

[Ruth Sheets]

Ok, I finally found this question in our testing system. And even though I was told it was a Blitz slidedeck question it is not! It came from AAPC materials. So I'll move this post back (somewhere) so you can see it.

You are correct that you should not use 52332 in conjunction with 52353. According to AAPC materials there is no global period for ureteroscopic procedures so the use of modifier 58 or 76 would not be appropriate. I believe the correct code should be simply 52352 because the stent replacement is bundled in. (I just verified that in CPT 2013 you could use 52332 in conjunction with 52353, so this question did not get updated properly in 2014. That is why the instructional note about 52332 and 52353 appears in green with the green arrows.)

I'll change the answer choices on the question in our system after I verify with Alicia since the question is related to the PBC course she teaches.

The good thing is that you were able to find that there was a problem with this question. Sorry for any inconvenience!

 

[joseyj62114]

Female patient comes in for BIL nephrolithiasis. Her left stones were treated ureteroscopically and her right stone was very large. It was treated with an ureteroscopic procedure. She comes in today for her second ureteroscopic procedure to remove the remaining stone fragments. Right ureteroscopy, laser lithotripsy and right ureteral stent exchange were performed. What CPT codes are reported for this service?

a. 52353-58, 52332-58
b. 52353, 52310, 52332
c. 52353, 52332-51
d. 52353-76, 52332-76

This is a copy of a question on my mock exam. (I hope I'm not getting in trouble for posting it here.) The correct answer is C. I picked A because I thought is was a staged procedure.
The note below 52332 says "Do not report 52332 in conjunction with ... 52353 .... when performed together on the same side." Isn't every answer breaking that rule?
Guidelines above on same page (pg 306) describes use of modifier 51 for use with 52332 when combine with other procedures.
It seems that these two rules are contradicting each other. Would you take a look at this for me. Thanks!

 

[joseyj62114]

Louise, thanks for posting this. I chose the same answer too, A, thinking it is a staged procedure. This question is on the Urinary Chapter Exam, Question 7. Now will have to go over Ruth's response to sort it out and understand the correct coding.

 

[Ruth Sheets]

I thought I had posted this correction before, but I can't find it now, so I probably did not actually post it. I agree that the answer is 52356. That is a new code for 2014, so it was not updated on a timely fashion as it should have been, but NOW it is. Also there is a problem with the 2014 CPT Index, in my opinion, because you can't get to this code by looking up the description in the index. No wonder the students are struggling with this... Sorry!

The correct answer to the question is 52356, and I changed it on all the exams with this question. Also, changed all the associated rationales to read as follows.

Rationale: Ureteroscopic procedures have no global period and the use of modifier 58 or 76 would not be appropriate. Though a stent exchange was performed, you do not report removal of the previous stent (52310), because it was not done as a separate procedure. In the Index, look up Cystourethroscopy/Insertion/Indwelling Ureteral Stent directing you to 52332. There is an instructional note stating not to use 52356 with this code. Looking and the code 52356, we see that it includes the lithotripsy and insertion of indwelling ureteral stent, so it is a more accurate code. There appears to be a problem with the 2014 index, because there is no way to get to 52356 directly from the index.