CCI 20.1: Urology Coders Should Focus on New Code 52356

Get pointers on ways to avoid claim denials when you use this new code with other urological procedure codes.

The latest round of CCI edits effective April 1, 2014, does some cleanup, bundling new 2014 codes with existing codes.  So even though your urology practice can take it easy this time, it still needs to focus on a new code – 52356.  Here are some helpful tips you need to know to avoid claims rejections when you use the code 52356 along with other urological procedure codes.

Avoid Ureteroscopic Stone and Lithotripsy Coding 

The latest edits bundle the new code 52356 with column 1 codes 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50081 (... over 2 cm). The bundling edit can be overridden (since it has a modifier indicator of “1”) most likely with modifier 59 and both the codes can then be billed and reimbursed.  If your urologist is unsuccessful in breaking up the stone endoscopically and he must then perform the ureteroscopic procedure, you may use modifier 59 to override this bundling.

When both procedures are used to remove the stone totally, bill 50080 or 50081 and 52356 during this same encounter. This may be an unusual scenario, but both procedures may be necessary and even the use of modifier on 52356 to get the reimbursement for the latter procedure.

Bundling Between 52356 and Column 2 Codes

Additionally, the April edits also create bundling between 52356 and the following column 2 codes: 50561, 50961, 50980, 52320, 52330, 52352, and 52353. These edits too have a modifier indicator of “1”, allowing unbundling of these pairs under some clinical circumstances.

Here’s an example to help your understanding: You may use modifier 59 to break the bundle between 52356 and 52352 or 52353 if your urologist performs the 52356 procedure on the right side of the patient and the 52352/52353 procedure on the left.

When a calyceal stone has also been removed at the same encounter from the same kidney when a renal pelvic stone has also been fragmented and a JJ stent placed, you can bill code 52352-59-76. 

Note: The bundling of 52352 with 52356 continues the previous similar bundling of these two codes 52353 and 52352, when 52352 is not supposed to be billed with 52353 while treating the same kidney stone.

If you’re not careful and up-to-date, you could face claim rejections. Ensuring you take the most appropriate bundling decisions for your urology practice and avoiding claim denials is not easy, but having a good SuperCoder CCIchecking tool (that alerts you with color-coded messages) can reduce your concerns by half!