When you remove a stent by pulling on the attached string that exists at the external urethral meatus and as it is attached to the stent. There is no special or specific CPT code for that. You should bill or include it in your E&M service. Bill code 52310 cysto and removal of stent without a modifier, when you do a cystoscopic extraction of a stent when the stent was placed after urethroscopies, and an accusized procedure or an endopyelotomy. Those three codes have zero day global. So you do not need a modifier. Bill the 52310 with modifier 58 when you do a cystoscopic extraction of a stent when the stent was placed after an ESWL 50590 any laparoscopic procedures such as of laparoscopic pyeloplasty 50544 or a percutaneous nephrostolithotomy 50080 and 50081. The modifier 58 is needed because these particular procedures have 90 day globals.
Now, what about proper coding for calcified stent removal? This occurs not too infrequently. The first one is where we have a calcified J-loop calcified in the bladder. You're going to do most likely a cystoscopic lithotripsy fragmentation of the stone, the stone forming around the J stent in the bladder.We suggest that you use the 52318, the complicated cystolitholapaxy because this is a stone that has formed on a foreign body to stent. Now, when you do after completion of the fragmentation of the stone and its removal from the end of the stent, the J loop, you remove the stent. And this also constitutes a separate procedure.
We also suggest that you use the complicated removal, the 52315. But that happens to be bundled in the 52318 and it is a separate procedure so we would add modifier 59 – so it does get paid. This is the complicated stent removal, we consider this complicated because the stent is still somewhat encrusted with debris and oftentimes it's somewhat difficult to manipulate and subsequently remove the stent.Now, what about if you have a calcified proximal J loop on the urethral stent? Well, you may treat the calcification on the J loop in the renal pelvis ESWL 50590. And if you do that and then remove the stent, again, use the complicated stent removal 52315 for the complicated stent removal because again, this stent is somewhat calcified and difficult to remove.
Now, I want you to notice that when you're doing an ESWL 50590, you can also bill for the placement of a stent, the 52332. And you can also bill for the removal of the stent cystoscopically whether it be 52310 or 52315. None of these codes are bundled into the ESWL. Or when you have a proximal loop calcification, you may want to do ureteroscopy and ureteroscopic fragmentation of the stone debris. And that would be code 52353. Now, unfortunately, you cannot bill for the cystoscopic removal of the stent as you did above because the code 52310 and 52315 are bundled into the 52353 code.
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