Key takeaways from this episode

• If a planned ureteroscopy and laser lithotripsy is aborted because the ureteroscope cannot pass the orifice, do not bill the stone codes (52352, 52353 or 52356). At minimum, bill the stent placement 52332 with modifier 22 for the extra effort; if the operative note shows the ureteroscope was actually used in a significant attempt, 52351 with modifier 52 plus 52332 is an appropriate combination, and the two are not bundled.
• Check whether a wire pushed the stone back into the kidney. If a guidewire or glidewire was passed and the distal stone was bumped up, 52330 (manipulation without removal of ureteral calculus) may apply; it includes ureteral catheterization but not leaving a stent.
• Bill what you actually did, and document it in detail for the facility's sake, but don't bend the code choice to help the facility. In this case 52332 and 52351 both fall in APC 5374, so the facility is paid the same either way; still document every piece of equipment used (including whether a suction or non-suction scope was used), because hospital contracts and ASC payment categories can depend on it.
• 51729 requires a documented urethral closure pressure profile, not just a leak point pressure. The descriptor's "i.e." parentheticals are directives: calibrated electronic equipment, a bladder voiding pressure, and a urethral closure pressure profile, ideally with functional urethral length. Documentation limited to Valsalva leak point pressure at 150 mL is not enough.
• 76942 and 76872 are mutually exclusive under the NCCI edits, which is why the three-code prostate biopsy claim is not paying. If all three are billed, the payer pays only 76942; many practices now bill 55700 with 76872 only, when a diagnostic transrectal ultrasound (prostate size, seminal vesicles, findings) is documented. 55700 is deleted January 1 and replaced with new codes.
• Fiducial marker placement is 55876, with 76942 for the ultrasound guidance when documented. Document how many markers were placed, what they were and where, and whether a diagnostic ultrasound or volume study was done versus guidance only.
• Use AUA Coding Today to check bundling edits and APC assignments before you bill. The hosts looked up both the 52351/52332 edit and the APC groupers live on codingtoday.com, which offers a free trial.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 252, recorded July 2025, with Scott Painter, Mark Painter and Dr. Ray Painter of PRS Network.

Coding an aborted ureteroscopy when only a stent is placed

[00:00] Scott Painter: On this episode: how to code for an aborted kidney stone treatment, and what is adequate documentation for a urethral pressure profile study. Also, prostate biopsy ultrasound coding, what's getting paid and what's not. And finally, how do you document and code for fiducial markers? Welcome to episode 252 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter and Dr. Ray Painter. We have some questions that came into the PRS help desk, which you can access if you go to prsnetwork.com and click on "coding question." You can ask questions, and we do appreciate the questions coming in. We'll do our best to answer them on the podcast.

Okay, let's get started. The first question we have came in from Michael, and Michael asks: If I have to abort a planned ureteroscopy and laser lithotripsy because the ureteral orifice is too narrow to pass the ureteroscope, so I place a stent, can I bill the 52353-52 and the 52332-59-51? All right, Mark, what guidance do you have for Michael?

Mark Painter: Well, this is one that ultimately is going to be a "depends" answer, I think. It sounds like this started off, obviously, with the intention of the laser lithotripsy, but it's obvious from the question, to me anyway, that they were unable to get the ureteroscope into the ureter. So that makes it difficult to really look at any type of stone code using a ureteroscope, a 52352 or a 52353. It does sound like they were successfully able to navigate a stent into the ureter, so we know we could do the 52332. There are a couple of things I'm thinking, and I'll let you guys go through it. A 52332 with a 22, because it was difficult and took more time to figure out that placing the stent was all you could do, and the navigation was difficult, and those attempts to get the ureteroscope in were difficult, would probably be the lowest you could end up billing. So that 52332 with a 22 modifier would reflect what you actually accomplished with that extra effort.

The consideration that makes me hesitate to say that's flat-out the right answer is that ultimately you've got the facility payment to consider, and I would assume that a ureteroscope was actually utilized in the attempt to get up to treat the stone. So you have the cost of the ureteroscope, whether it's disposable single-use or a standard ureteroscope, that now is part of the expense of things that were utilized. So could you consider a failed diagnostic ureteroscopy, a 52351 with a 52 modifier, as an explanation, and then use the 52332? I do not believe those are bundled, but we should double check to see if we needed a 59 modifier.

Scott: Or an XU.

Mark: So let's look that one up and see what our bundling says. And those are both okay. So a 52351 with a 52 and a 52332 would be an appropriate coding combination, instead of the 52332 alone, if in fact the operative note demonstrates that the ureteroscope was utilized and the attempt to get into the ureteral opening was significant. But I don't think that, with the inability to get the ureteroscope into the ureter, we could look at any of the stone codes, either manipulation or laser, because we didn't do that.

Scott: Ray, your thoughts.

Dr. Ray Painter: Mark, I agree with you. I think we can certainly justify whatever we tried to do and couldn't, and then there's always the ambiguity of what we had originally attempted to do and couldn't do. But somewhere in there, if I remember right, it says that if you do fail, you can charge for what you did do. So I think you're right. If you attempted to use the ureteroscope, I would certainly try to charge for it. If you just looked in and saw that the opening was too narrow and you didn't even try to use the ureteroscope, then I think there is an argument that you shouldn't bill for that either.

[06:00] Mark: Yeah. And the other thing I was thinking about, and again I don't know from the question whether this actually occurred, is: in the attempt to get the ureteroscope in, were they able to push a guidewire or a glidewire in through the ureteral orifice and bump the stone back up into the kidney? Was it in the distal ureter? That would be another thing to look at, to see if potentially the 52330 might be another one that was in there. That's manipulation without removal of the ureteral calculus using the cystoscope. It does include ureteral catheterization, but it does not include the leaving of a stent. So again, we need a little more detail to see if that was maybe another thing that happened during the case that's not in the question.

[07:00] Ray: If I understand you correctly, what you're really saying is that what you've documented that you actually tried to do, or were able to accomplish, during the procedure that you had to abort, you should charge for.

Mark: Yes, and put your 22s on, or your 52s, based on what you actually did. But again, I wouldn't think that the 52352, or the 56, or the 53 would be appropriate in this case. You didn't get the ureteroscope up there.

Ray: Now, Mark, tell all our listeners how you were able to find the bundling so easily.

Mark: Of course, I looked it up in Coding Today.

Physician documentation and the facility payment

Scott: Yes, AUA Coding Today, codingtoday.com. You can go there and get a free trial and look up some codes yourself if you aren't already a subscriber. One other question I have for you. You mentioned that when you were looking at this, you looked at the facility possibly getting paid or not, depending on what the physician is coding. How much is the responsibility of the physician to think of that, thinking of the facility? What is their responsibility in making sure that is communicated through their coding?

Mark: Well, without a doubt, it's a factor that needs to be considered, but you can't bend the rules just to make the facility happy. That really has to be the documentation that supported that the ureteroscope was put in, the glidewires were up, we began the navigation process, we were unable to pass the orifice. It really needs to be detailed in that regard, to support what was actually performed. It is a consideration that, in fact, that equipment was utilized and it is an expense that was incurred, but you can't manufacture what wasn't done. So I would put it as a consideration, but certainly not the driver. The driver needs to be, as always, the documentation.

Scott: So if the documentation does state that the ureteroscope was used, but then Michael billed the 52332 with the 22, would that probably be enough for the facility to get payment on that, even though it's not a ureteroscopy code?

Mark: So the payment for the 52332, because that was the only code that was billed, right? That is where the facility payment would drive. The 22 does not take that into account. And that's APC grouper 5374, which pays $1,655.31. So a 52351, and that's also on Coding Today, you can look those things up, a 52351 has an APC that is 5374, which means it's the same grouper whether you do it one or the other. So in this case, even if you run that consideration down, it's really about what you did or didn't do. The facility's going to get paid the same.

Scott: Got it.

Ray: But that's not always the case. So I think it all boils down to the fact that you do have to document for reimbursement as well as for the clinical. And it is the doc's responsibility to be sure that they have documented exactly what they've done, and charged what they document, so that the facility can be accurately paid. Because many times, when you have a procedure where you charge for this versus that, it may pop the facility fee up to a much higher category, and in particular, if you're in the ASC and you own it, you definitely want to pay close attention.

Mark: That is true. And hospitals also have different payment protocols that allow them to count equipment used, so it's important to categorize all the equipment used as well, because there may be some additional catchment that may not translate into reimbursement for that particular case, but could be factored into the overall conversion factor or payment level the hospital gets, based on what the contract is. So all of that needs to be considered and well documented. And that is one of those things that, as we start to see more and more folks who are part of an ASC, and they're a little more tied to the reimbursement of the facility, it's really brought to light: making sure that you are clear in your documentation about the equipment utilized, whether it's a suction scope or a non-suction scope. Those things all make a difference to both the physician and the facility, and need to be in the documentation.

What documentation supports 51729

Scott: Okay, let's move on to the next question. The next question comes in from Don, and Don asks: Can you clarify what documentation is required to be able to code the 51729? Is the length of the urethra required to be documented, or is it just a possible element? The 51729 is the urethral pressure profile. And she goes on to ask: My provider is only documenting leak point pressure testing, volume tested 150 milliliters, stress-induced, Valsalva leak point pressure, no leak. She wants to know, is that enough for the 51729?

Mark: Okay. First, I think it would actually be helpful, Scott, to read the full description of the 51729.

Scott: All right. 51729 is complex cystometrogram (i.e., calibrated electronic equipment), with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique.

Mark: Okay, so the reason I had you do that is because what we're really trying to decipher is what is included and what's not included in that particular description, and how we'd interpret that. And to do that, we need to understand what "i.e." means. "I.e.," of course, is Latin, and it means "that is," or "in other words." So it is a very different parenthetical than something that is "e.g." "E.g." is "for example." So essentially, with all the parentheticals, we are given the directive that "that is." So we have to use calibrated electronic equipment, we need to get a bladder voiding pressure, and for our UPP, we do need to get the urethral pressure measured. That is what we would need to have documented.

Now, the older description of 51729, prior to the change, when we actually had a UPP that was separate, was an "e.g.," and it did include a leak point pressure, so it was a little bit more forgiving as to what could have been documented in the past to get a UPP. Now it does look like the 51729, given the description that is currently in the CPT manual, would require that urethral pressure profile, and that needs to be done and documented within the record. So you would need to measure the actual urethral pressure, the pressure that the urethra puts on the wall of the catheter. Typically you would measure the length of the urethra, or the functional length, as well. You do want to make sure that you at least have that urethral pressure. That profile would indicate that you probably want the functional length as well. So those are the two things that I would think would be important in your documentation to support the 51729. But it does say, and Scott, you read it, a urethral closure pressure profile. So that is the piece that needs to be documented. The closure profile is the meaningful piece of information that should be included in the documentation.

[17:00] Scott: And should you say "the urethral closure pressure is" such and such? Do you need to use that documentation?

Mark: That would be the ideal.

Scott: Not just "urethral pressure profile."

Mark: Yeah, not just that. You could certainly include that, but it looks like, with that "i.e.," what needs to be included is the urethral closure pressure profile, if someone were being really ticky-tack.

Scott: All right. So in answering Don's question, is what they documented enough? The answer is no, probably not.

Prostate biopsy: 55700, 76942 and 76872 bundling

[18:00] Scott: Okay. Let's move on to the next question. The next question comes in from Chris, and Chris asks: Can you tell me the best way to document and correctly bill for prostate biopsy using the 55700, 76942 and 76872? I am told we're no longer getting paid for those. So that's the first part of the question. We'll answer that one first. What's happening here, Mark?

Mark: This is the bundling issue with 76942 and 76872. Ultimately, what we've seen is that 76942 and 76872 are, in the bundling edit, considered exclusive codes. The 55700 is not at risk at this point in time, but as we talked about last week, the 55700 is going to be deleted January 1, so we'll have new codes.

Scott: We should probably read the descriptions for those who don't have the codes memorized.

[19:00] Mark: Fair enough.

Scott: Okay, let's go. The 55700 is biopsy, prostate, needle or punch, single or multiple, any approach. 76942 is ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation. And the 76872 is ultrasound, transrectal. All right, back to you, Mark.

Mark: Okay. So the 76872, as you could see by the description, is a diagnostic transrectal ultrasound. This is, if performed, something the documentation would support: that you are looking at the prostate, typically through a transrectal ultrasound, and you would document what was seen, what is the size of the prostate, the seminal vesicles, where are they located, those types of things. That would be typical for a diagnostic test. The 76942, you can tell, is really ultrasound guidance of the needle. And what they're saying with the exclusive language is that if you bill both, a modifier is allowed. If you want to try and bill both, and the payer follows those and says, in fact, those are separate efforts, they could pay for both the 76872 and the 76942 with a modifier 59 on 76942. But it is one of those areas where it is very difficult to argue that that diagnostic test did not provide you with the map to find where you are going to biopsy the prostate, and that is why they have made those mutually exclusive.

Typically, if all three were charged, and they followed the guidelines, they would pay for only the 76942 if they did not believe that to be a distinct procedure from the 76872. So what a lot of folks have done, if the diagnostic is documented appropriately, is bill the 76872 only, with the 55700, instead of billing all three codes. Again, next year we'll start to see that change a little bit, or we're expecting that to change, with the parentheticals and the new codes.

[22:00] Scott: Ray, your thoughts.

Ray: No comment.

Fiducial marker placement under ultrasound guidance

Scott: Okay. Finally, Chris had a second question in his help desk entry, and the second question is: What is the best way to document and code for placement of fiducial markers under ultrasound guidance?

Mark: So, documentation first. Obviously, you're going to document the use of the ultrasound. Did you do a diagnostic ultrasound or a volume study, anything along those lines? You would want to document that piece of the process, versus were you just doing guidance for the placement of those particular markers. So make sure that documentation is there. You want to document as well how many markers were placed, what the markers were, and where they were placed. That's the documentation standpoint. From a coding standpoint, 55876, which is placement of interstitial devices for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate, via needle, any approach, single or multiple, is the code for the placement of the markers. We could look at 76942 for the guidance, the ultrasound guidance to place those markers, if that is supported by the documentation.

Scott: Ray, comments?

Ray: There's no way I can improve on that.

Scott: All right. And I don't have any questions on this either, so I think that made sense.

Sponsor and the PRS Coding and Reimbursement Hub

[24:00] Scott: Okay, let's wind this episode up here. We want to thank ModMed for supporting this episode. If you are in the market for an EHR or a practice management system, you can go to modmed.com/prsnetwork for specials for our listening audience. Also, I want to remind you that the PRS Coding and Reimbursement Hub is up and running. We are working on populating this more. You can go take a look at it at prsnetwork.com/urologyhub, and on the hub, as we've shared on the podcast before, we have things broken down by category as well as by device and/or pharmaceutical. We are adding more content all the time, so please check in on that. Right now you can check in on upper tract urothelial cancer and Jelmyto and how that's coded. You can also look at urodynamics as well as kidney stones, and various products associated with those as well. All right, let's get some final thoughts here. Mark, final thoughts.

Final thoughts

Mark: Well, first of all, it was refreshing to get back into just straight coding after spending a couple of weeks diving into all the rules and regs and what's going to happen in the future. That was fun, to get back to some of the day-to-day blocking and tackling, which no matter what, we're going to have to keep doing. Ultimately, I think today's real focus was on really understanding, as we've done throughout, what does the code say and what does your documentation say? Understanding that link between, clinically, what was required and what was provided to provide care to your patients needs to be reflected in the CPT codes selected. But that documentation really needs to support what was done and how it was done, and that's something that I think folks need to continue to improve on. Whether you're using AI, a scribe, or just straight dictation, you want to make sure that what you did doesn't just stay in your head, but gets translated into the medical record to support both the clinical and the reimbursement in today's environment.

Scott: And the rules that you need to consult, there are a lot of them, a lot of little things, and we showed you that on today's episode when we were consulting AUA Coding Today for some of those rules. We looked up bundling, and we also looked up the APC amounts and rates on Coding Today. It's just a great, handy resource to have. So again, I think that supports really having that tool available and ready for you at all times when you're doing your documentation for reimbursement. Okay, Ray, final thoughts.

Ray: You have to have a knowledge of the rules in order to really accomplish reimbursement for documentation, which is so crucial this day in time, and the tools you need to really check to see whether you're doing it right or not. Coding Today is a good source.

Scott: All right. That's all we have for today's episode. Thank you all for listening. Take us out, Ray.

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