Three Pointers To Help You Avoid Common Stent Coding Mistakes

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When your urologist places a stent after a ureteroscopic procedure (say for instance stone removal, the coding is not always cut and dry. You will need to dig into the documentation details to ensure you select the proper code for the clinical circumstances.


Here are three pointers which will help you stay away from the most common stent coding mistakes.


Get to know when the stent is not really a stent


Not each and every mention of ‘stent' in your urologist's documentation means you can report a stent code such as 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]).


Here's the reason: There are two types of stents your urologist will make use of - temporary and permanent - and the first one is not really a true stent. A temporary stent is in actuality a ureteral catheter, placed at surgery to assist during surgery. The urologist then removes the catheter post surgery before the patient leaves the operating room. In this situation, you should not report stent code 52332. Instead, use 52005 ...
... (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service).


For postoperative drainage stents, stick with 52332


The second type of stent is a permanent stent. These types of stents are placed after surgery for drainage, and are indwelling and self retaining. The patient goes away from the operative room with the stent in place, and the stent will be removed at a later date.


Whereas temporary stents that are often placed as part of an endoscopic procedure (52320-52355) can't be reported in addition to the primary procedure, an indwelling stent, which is placed during the procedure to keep the ureter open and to aid recovery after the procedure can be billed separately.


Here's how: When your urologist documents that he placed a double-J stent for postoperative drainage, you should use 52332.


Bilateral coding: If your urologist places bilateral double-J stents for postop drainage, your exact coding will depend on the payer. For Medicare, use 52332 with modifier 50 (Bilateral procedure) appended. Private payers may also want 52332-50 or they may request you use 52332-LT (Left side) and 52332-50-RT (Right side) on two lines.


In many instances, report stent placement separately


If your urologist places a stent during the same session in which he also carries out another ureteroscopic procedure, most likely you can report both procedures.


When the patient has a large ureteral stone which the urologist removes ureteroscopically, there may follow a significant amount of ureteral swelling. In order to avoid complete ureteral obstruction, an indwelling ureteral stent may be placed to keep the ureter open."


In this situation, bill the ureteroscopy code (52352, Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]) and 52332. For some payers you may need to add modifier 51 (multiple procedures) to 52332 to indicate that you have carried out a secondary procedure. You don't need to add modifier 59 (Distinct procedural service) as because 52332 is no longer bundled with 52320-52355.


For more on this and for other specialty-specific articles to assist your urology coding, sign up for a good Medical coding resource like Coding Institute.