Code 52332 is no longer bundled into the 52320 cystourethroscopy and removal of the urethral stone or 52330 cystourethroscopy, and manipulation of the stone without removal. It was no longer bundled into the 52341 cysto and treatment of urethral strictures. And it was no longer bundled into ureteroscopy codes and procedures up to 52354. So modifier -59 is not required when you bill the 52332 with the above code.
When you talk about urethral or stent placement codes, any time you put a stent up cystoscopically in a retrograde placement, it means going against the flow of urine, and you have to use the code 52332. Any time you do a ureterotomy, open the ureter and place a stent - and this is an open usually through an abdominal incision— use the code 50605. When you do a percutaneous placement through the renal pelvis antegrade of a ureteral stent, use the code 50393.
Now, when you do that code according to the CPT Assistant, you should also bill for the percutaneous access of the renal pelvis. So, you would bill the 50393 replacing the ureteral stent down. And you would also bill for the percutaneous nephrostomy, the 50392. And since this procedure is bundled into 50393 but it is a separate procedure and the bundled can be broken, add modifier -59 to the 50392.
When you pass a ureteral stent, unilateral or bilateral, up into the ureters from an ileal conduit or through an ileal conduit, the AUA has told us to use the code 44383. That's looking in the conduit, doing an endoscopy of the conduit and finding ureteral losses and placing a stent up.
Now, we also have the placement of a stent, unilateral or bilateral, we use through an abdominal pouch diversion which is a pelvic pouch. Now, this may be an Indiana pouch, the Cock pouch, the Miami pouch. And if you do that, bill the 44385 which is the pouchoscopy and add -22 modifier for the extra work that you performed putting up a stent. Or use code 44385 which is pouchoscopy. And because the abdominal pouch is a substitute for the urinary bladder, the AUA through the Physicians Reimbursement Service have told us that you can bill the 52332, the placement of the stent through the substitute bladder.
Now with modifier -52 that indicates that I placed a stent but I did not do a cystoscopy, use that as your primary code. And as your secondary code since you did not do a cystoscopy because the bladder is not there but you did a pouchoscopy, bill the code 44385.
What about ureteral stent removal and sometimes replacement?
If you remove a stent cystoscopically and replaced it cystoscopically, use the code 52332. If you remove a stent unilateral or one stent via cystoscopy, use the code 52310. If you remove bilateral stent or it's complicated, maybe you have two stents of one side, more than one stent or bilateral via cystoscopic approach, use the code 52315. And the reason for using that for bilateral stent removal is that the code 52310 does not accept the -50.
What about percutaneous removal and replacement?
Use the code 50382. And if you just remove the stent percutaneously, 50384. If you have a transnephric stent going through the kidney into the renal pelvis and down the ureter and you replace that using coaxial technology, endourological technique, use the code 50383. What about taking out stents and putting them back to ileal conduits? If you look in and you do an ileoscopy and then remove the stent, bill for the removal of the stent, 52315 with modifier -52. Use the complicated stent removal because the stent that you are removing from an ileal conduit is usually encased with mucus and foreign body, making the removal a little bit more difficult. Add the modifier -52 because you're not doing it cystoscopically. The bladder is not there. And then replace the stent using the code 44383 which is ileoscopy and placement of the ureteral stent.
What about an abdominal pouch?
Well, you do a pouchoscopy, the 44385, and you remove and replace a stent using the code 52332 with modifier -52. You can use this code because the pouch is a substitute for the bladder. You use modifier -52 to indicate that you did not do a cystoscopy but you did a pouchoscopy, the 44385. Now, we have a code, 50688, which is an external coaxial replacement using endourological (skill) technique through an ileal conduit to replace the stent.