When we use postoperative stents for drainage, they are usually double J ureteral stents or some type of double J. They are not the straight whistle-tip or olive-tip catheters. And the CPT code for placing a J stent or some type of J stent is 52332. When you do this bilaterally for Medicare, you would bill the 52332 with modifier -50. Now, for private insurance, commercial, non-Medicare private insurances that do follow Medicare policies, you could bill the code 52332 with modifier -50.Or as most common, for private or HMOs, we suggest billing on two lines – 52332 left LT modifier, 52332 RT right modifier. And many times we suggest putting in the -50 modifier as the primary modifier and then the right side to follow.
We did imply that code should be 50605 ureterotomy. It's an open abdominal procedure with the insertion of an indwelling ureteral stent, all types. So that would even include putting in the ureteral catheters. Now, for bilateral, it's 50605 modifier -50. And your diagnosis for putting this in is the 591 V07.8 if you're doing this prophylactically to avoid hydronephrosis.
And we say we're going to talk about stent exchange and bundled codes. The 52310 is a cystoscopic or urethrocystoscopy with removal of a stent (or foreign body). This code, the 52310 is bundled into stent placement, the 52332. And it cannot be charged in addition to the 52332, so that when you perform a cystoscopic stent exchange, whether it's for Medicare or any other carrier HMO, bill only the 52332 for the stent exchange. Also remember that do not bill the 52005 cysto retrograde pyelogram because that is included in the 52332. And this edit cannot be unbundled with any modifier. However, if you interpret the retrograde pyelogram, you can bill the 74420 -26 for a payment of anywhere from $18 to $28.
Now, if you are going to bill for the interpretation of the retrograde pyelogram, you must document this. And you can document it in the operative report providing it's separate from the operative report. And if you do this in the middle of the operative report, you document it, you may want to say - make it a new paragraph “Radiological findings”. Some urologists will do their radiological interpretation and documentation at the end of the operated dictated report.
If you're going to do this, you must have certain elements in your dictation. You must dictate the size and type of urethral catheter, a five-fringe Pollack. You must indicate the amount of contrast agent you injected and the type of agent like you would say, “Using a five-fringe Pollack catheter, injected 8 ccs of 30% conray into the urinary system. And then you'd have to give a nice prescription very much like what the radiologist would do. You cannot say it's normal or no abnormalities. They're not going to pay you for just those words. You'd have to say injected contrast went up the urethra without obstruction filled out a normal looking renal pelvis with no evidence of stone, tumors, compression or abnormalities. Urethral pelvic junction was not obstructive.
Now, your initial ICD diagnosis for the stent exchange is usually the same diagnosis for the initial reason for the stent usually hydronephrosis 591. As a secondary diagnosis, use the code V53.6 which says fitting or replacement of a urinary catheter.
And again, as we mentioned, if you removed bilateral stents, not replacing them, just removing them, use the code 52315. And the diagnosis for removing a stent whether it's unilateral or bilateral should be foreign body 939.0 foreign body of the urethra and/or bladder.