Multiple lithotripsies

A patient with a left ureteropelvic junction (UPJ) and bilateral renal calculi was scheduled to undergo multiple lithotripsies at our facility. A bilateral lithotripsy with stent placement was performed utilizing a Holmium laser on the right and left kidney. Additionally, bilateral retrograde pyeloureterograms, and a right extracorporeal shockwave lithotripsy of the right inferior kidney was also performed. Per coding guidance it would be inappropriate to report the removal of multiple kidney stones from the same side. The National Correct Coding Initiative (NCCI) states: “the unit of service (UOS) for a procedure describing destruction or removal of renal system calculus(i) is one (1). The UOS is not each calculus. If a procedure for destruction or removal of renal system calculi is performed bilaterally, the CPT code may be reported with modifier 50 and one (1) UOS.” What are the correct code assignments for the multiple lithotripsies performed in this case? ...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews a urology coding scenario involving multiple stone-related procedures performed during one encounter. It is aimed at coding professionals who need to understand how bundled stone procedures, bilateral reporting, and NCCI guidance are discussed in the context of CPT coding. The article focuses on general coding considerations for a case that includes endoscopic, imaging, and shockwave lithotripsy services.

Why This Topic Matters

Stone treatment encounters can involve several procedures in one session, and correct reporting affects claim accuracy and compliance. This article is relevant for coders seeking to understand how payer-edit guidance and bilateral procedure reporting are addressed in a complex lithotripsy case.

What You Will Learn

  • How a multi-procedure stone treatment encounter is presented for coding review
  • How bilateral service reporting concepts are discussed in relation to stone procedures
  • How NCCI guidance is referenced in the context of renal calculus destruction or removal
  • How coding professionals evaluate a urology case involving multiple related services

Who Should Read This

  • Medical coders
  • Coding auditors
  • Urology billing staff
  • Compliance professionals

Codes Discussed

  • CPT: 50

Modifiers Discussed

  • CPT: 50

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