Overview

Kidney Stone Coding: Proper Documentation and Billing Guidelines

When coding and billing for kidney stones, make sure the documentation includes the following information:

• Medical Necessity

• Size

• Location

  • N20.0 – Kidney stone (calculus of kidney)

  • N20.1 – Ureteral stone (calculus of ureter)

  • N20.9 – Unspecified urinary calculus

• Approach (ESWL, PCNL, Endoscopy, Pyeloscopy)
  • Shockwave Lithotripsy (ESWL)
    50590 – Extracorporeal Shock Wave Lithotripsy (ESWL)
    
    
  • Percutaneous Nephrolithotomy (PCNL)
    50080 – PCNL for kidney stones up to 2 cm
    50081 – PCNL for kidney stones larger than 2 cm
    
    
  • Ureteroscopy with Laser Lithotripsy (Only one lithotripsy per side may be billed)
    52356 – Ureteroscopy with lithotripsy and stent placement
    52353 – Ureteroscopy with lithotripsy (without stent)
    
    
  • Manipulation, Basket Removal, or Vacuum
    52320 – Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus
    52330 – Cystourethroscopy with manipulation without removal of ureteral calculus
    52352 – Cystourethroscopy, with ureteroscopy and or pyeloscopy with removal or manipulation of calculus
• Stents if Used
  
  • Ureteroscopy with Laser Lithotripsy and Stent
    • 52356 – Ureteroscopy with lithotripsy and stent placement
  • Insertion of an Indwelling Stent
    • 52332 - Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

Other Considerations

• Modifier Use:

  • Modifier -59 (-XS) may be required when performing multiple stone procedures. 
    (Note: You may not report codes 52356 and 52353 on the same side with a -59 (-XS) modifier)

  • Modifier -22 is used when a procedure requires significantly more effort than usual. 
    
    

    Example of Modifier 22 in Practice

     

    Scenario: Steerable Ureteroscopy with Suction Technology

    Standard procedure: Breaking stones with laser, relying on natural clearance.

    Enhanced procedure: Using suction to actively remove stone fragments, requiring additional laser work and extended scope manipulation.

    Documentation: “The procedure required 2 times the amount of operative time than the normal time to ensure a completely clear the kidney due to the number of stones, the structure of the stones resulting in irregular fracture and the anatomy of the kidney. Additional operative time was required full explore and evacuate stone burden reducing post-op complications and risk of repeat stone formation.”

    Justification: This extra effort places the procedure in the statistical ‘tail’ of the standard bell curve, warranting higher reimbursement.
    
    

  • Modifiers -LT and -RT

    • These modifiers are necessary when a bilateral organ, such as the kidneys or ureters, is involved and a procedure is performed on only one side.

    • They are applied to unilateral procedures to differentiate between treatment on the left and right kidney or ureter.

• Global Period Awareness:

  • Most kidney stone procedures have a 90-day global period, related post-operative follow-ups are not billable unless complications requiring a return to the Operating/Procedure Room.

 Product Specific Coding and Reimbursement Information

CVAC System