“Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service,” writes Jonathan Rubenstein, MD, and Mark Painter.
Could you tell me what the appropriate diagnosis would be when a patient goes in for surgery to have a ureteral stone (52351 and 52332) removed and a stent placed and the stone is no longer present, presumably it has already passed?
Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service. The service performed is an HCPCS [Healthcare Common Procedure Coding System] code, either Level I or Level II. The accompanying reason is chosen from the International Classification of Diseases 10th Revision With Clinical Modification (ICD-10-CM).
In the situation described, a patient is brought to a procedure room to perform what is scheduled as a removal of a ureteral stone and a stent placed, which encompasses 52352 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with
removal or manipulation of calculus [ureteral catheterization is included]) and 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [eg, Gibbons or double-J type])or similarly for laser lithotripsy and stent placement, 52356 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent [eg, Gibbons or double-J type]) for the indication of N20.1 stone, ureter.
However, upon performance of the case, the patient was found to have passed the stone and the patient had undergone a diagnostic ureteroscopy and stent placement (CPT codes 52351, cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic and 52332, respectively). Assuming there was no other pathology found and no stone found but the patient was treated with a stent, the indication for the procedure remained unchanged. Therefore, ICD-10-CM code N20.1 should still be chosen per ICD-10 guidelines, which indicate in the absence of another, more appropriate diagnosis, the intended reason for the service should be reported even if the condition no longer presents.