FAQs – Coding for: 1) ESWL & Pancreatic Stones 2) Uroflow & TURP global

Coding and billing – Knowledge versus understanding.

One can have a lot of knowledge about coding and billing, certifications, Etc. etc. However, if one does not have a good “understanding” of the system and how it works, applying logic to new scenarios may not work. These questions are a little out of the typical wheelhouse of urology coding knowledge, but the illustrates, if you know the system, you can use logic to help solve the uncommon coding questions.

Question 1

How should I code for the following procedure Extracorporeal Shockwave Lithotripsy, ( E S W L), Pancreatic Duct Stones?

Findings: Careful fluoroscopic imaging around the region of the pancreas demonstrated no obvious radiopaque stones that could be safely treated with ESWL.

Description of Procedure:
The patient was taken to the operating room and placed in the prone position. After adequate anesthetic was initiated, the patient was prepped and draped in the typical fashion. Review of the patient’s preoperative CT scan, KUB, and ERCP images with cholangiograms demonstrated what appeared to be a filling defect on the cholangiogram. Careful fluoroscopic imaging over the region of this finding demonstrated no evidence of radiopaque stones. Fluoroscopic imaging was undertaken in the region of the pancreatic head following the spine over the entirety of the upper abdomen. Examination of the tail was also undertaken. Because I was unable to identify any radiodense stones that would be amenable to treatment, I elected to terminate the procedure. . The patient was taken to recovery in stable condition.


Although an argument could be made for the “52-Reduced Services” or the “53-Discontinued Procedure” modifier to be appended with the “50590-Lithotripsy, extracorporeal shock wave” procedure code. I am inclined to recommend that only the flouroscopy code be reported, as it does not look like patient received any treatment related to the ESWL other than the Anesthesia which would be reported separately.
If the patient was being positioned for ESWL and imaging occurred in that regard, the ESWL 50590 procedure code with the above mentioned modifier(s) would be more appropriate.

The logic in the answer could apply to any similar or related ESWL.

Takeaway Message –  Knowledge is not static. One needs to continually question their knowledge and keep up-to-date own changes.


My coder told me I could bill for a uroflow during the global period of a TURP.
I distinctly remember you saying, at one of your seminars, that we could not bill for a uroflow after a TURP. Who is correct?

Answer #2

The seminar was probably several years ago and at that point in time you would’ve been correct. However since that time, Medicare has changed the global status of uroflow. Now in Medicare, the uroflow CPT codes are assigned – Global: “XXX” – that means the global concept does not apply to that procedure. Therefore, the uroflow procedure should be allowed when billed within a post-operative period, such as within the 90 days post TURP.

The bottom line – we should all commit to continue learning and a better understanding the System.