Coding for stent removal is tricky, especially when the stent has migrated and gone up and has been displaced and becomes an intra urethral stent or foreign body. For its removal, we would suggest that you bill the ureteroscopic code for its removal by using the CPT code 52351, and add modifier 22 for the extra work that you may be doing in removing the stent. The 52310 and the 52315 are the removal of stones or stent. They are bundled and you cannot unbundle. They are bundled into the ureteroscopic code, the 52351. You may want to use the code 52352 for a ureteroscopic stone removal. It does not say foreign body removal. In fact, there is no ureteroscopic code that does say ureteroscopy and foreign body removal. However, if you have a stone at the end of a migrated stent and you extract the stone ureteroscopically and along with the stone comes the stent, then you could bill for that particular problem and procedure—the 52352 with the diagnosis of urethral stone 590.1. And then the foreign body in the ureter, your diagnosis for this foreign body in the ureter would be 939.9.
Coding For Intestinal Stent Exchange
When you are coding for intestinal stent exchange, we've been told by the AUA that endoscopy of an intestinal segment with insertion of a ureteroileal stent. This was reported in the AUA coding and reimbursement question and answer session of their website in August that you can use the code 44383. That's an ileoscopy with transendoscopic stent placement.
When you are removing the stent and also putting a stent up through an ileal loop, bill the code 44383 for the ileoscopy and the insertion of the stent. You could bill for stent removal using the code 52315 because the ileal loop is a substitute bladder. But add modifier 52 because you did not do a cystoscopic examination. You did an ileoscopy while looking into the loop. When we have intestinal stent exchange through a pelvic or abdominal pouch, again, the Cox, the Indiana or the Miami pouch, use two codes—44385 for the endoscopy or the pouchoscopy and 52332 for stent removal and placement. You can use this code because the abdominal pouch is a substitute bladder. But you're adding the reduction modifier 52 to indicate that you did not do a cystoscopy. You did this through pouchoscopy or an endoscopy of the abdominal or pelvic pouch, the 44385.
Now, when you use the code 52332, it will accept ICD diagnosis, hydronephrosis 591 or for the replacing the stent or and/or for the foreign body removal, the 939.0.
External Urethral Stent Exchange In An Ileal Conduit
Let's look at an external urethral stent exchange in an ileal conduit, where we can use the code 50688. This is an ileal conduit external category, coaxial stent exchange using endourological techniques. This would be used unilateral or bilateral. Prior to changing the stents, you may do a retrograding injection and a retrograde pyelogram using these indwelling stents coming out to the indwelling urethral catheters or stents coming out of the exit of the stoma. And if you do an injection of the stent and get a picture, you can bill the code 50684 modifier 50 for bilateral. If you do the retrograde pyelogram through the stent and you do an interpretation and document that, you may also bill the 74420 modifier 26, which is an interpretation of the retrograde pyelogram.