Why this confusion happens: HCPCS vs CPT

HCPCS (Healthcare Common Procedure Coding System) is a CMS-maintained coding system with two tiers:

• Level I: CPT codes (five-digit numeric codes, maintained by the AMA).
• Level II: Alphanumeric codes for items and services not in CPT — including the “C” codes used in OPPS/ASC facility claims.

If a code starts with “C” and is an OPPS/ASC HCPCS code, it is generally intended for facility billing. Physicians report CPT codes for the professional service and do not report OPPS “C” procedure codes.

Common ureteroscopy/lithotripsy codes

• 52353 – Ureteroscopy with ureteral/renal pelvic lithotripsy
• 52356 – Ureteroscopy with lithotripsy and indwelling ureteral stent insertion

Choose the CPT® code based on what was actually performed: ureteroscopy/pyeloscopy, lithotripsy, stent placement, and related work.

Important physician rule: physicians do not bill C9761.

Practical reporting distinction:

• Physician / professional claim: CPT® only, as appropriate to the documented services.
• Facility claim: may report C9761 when the procedure used the CVAC System and documentation supports the full descriptor.

Prior authorization practical point: when authorization is required, be explicit that physician authorization is for CPT® and facility authorization is for C9761.

Common diagnosis codes for kidney stone cases include:

• N20.0 – Calculus of kidney
• N20.1 – Calculus of ureter
• N20.2 – Calculus of kidney with calculus of ureter

Always code to the highest level of specificity supported by the record.

Physician documentation should clearly support the professional service billed and align with the facility record if the facility is reporting C9761.

What the physician operative note should state clearly

• Scope & access: cystourethroscopy with ureteroscopy and/or pyeloscopy performed.
• Lithotripsy: lithotripsy performed, when applicable to the case.
• Evacuation method: describe vacuum aspiration/fragment evacuation clearly — not just “suction.” The note must support steerable vacuum aspiration via a steerable ureteral catheter.
• Device identification: include the actual device used, i.e., the CVAC System.
• Stone burden / outcome: describe fragments, debris removal, clearance intent, and residual burden when relevant.
• Stent status: document whether a stent was placed and laterality if applicable.

Standardization tip: use a consistent phrase in the operative note when the CVAC procedure is performed.

Suggested phrase:
“Steerable vacuum aspiration of the kidney/collecting system was performed using a steerable ureteral catheter (CVAC).”

• Modifier Use

  • Modifier -59 (-XS) may be required when performing multiple stone procedures.
    Note: You may not report codes 52356 and 52353 on the same side with a -59 (-XS) modifier.
  • Modifier -22 may be considered when the procedure requires significantly more effort than usual.

    Use with care: documentation must support why the case was substantially more difficult than the typical service and quantify the extra effort in a concrete way.

  • Modifiers -LT and -RT
    • Use when a bilateral organ such as the kidneys or ureters is involved and the procedure is performed on only one side.
    • These modifiers help distinguish left versus right kidney or ureter treatment.
  • Modifier -50 Bilateral
    • Use when the identical service is provided on both sides during the same encounter.
    • Some payers instead require separate RT and LT lines.
    • Always follow payer-specific bilateral reporting rules.

• Global Period Awareness

  • Most kidney stone procedures have a 0-day global period. Exceptions commonly include ESWL and PCNL procedures, which typically have 90-day globals.

• Common Physician-Side Pitfalls

  • Using only generic suction language: this is too weak if the facility intends to support C9761.
  • Omitting the device name: failure to mention the CVAC System weakens alignment with facility coding support.
  • Op note / facility mismatch: physician documentation that reads like standard URS only while the facility reports C9761 invites denial and audit risk.
  • Confusing CPT and HCPCS roles: physician reporting remains CPT-based even when the facility uses a C-code pathway.

The high-confidence rule: who bills what

• Physician / professional claim: report the applicable CPT® ureteroscopy/lithotripsy code(s) — commonly 52353 or 52356 — depending on services actually performed. Physicians do not bill C9761.
• Facility (HOPD): report C9761 for the CVAC procedure. Report device code C1747 to indicate a single-use urinary tract endoscope on Medicare claims in 2026. There is no pass-through payment associated with C1747 in 2026, but the code is active and used for tracking purposes. The hospital should determine appropriate charges for items and services.
• Facility (ASC): report C9761 for the CVAC procedure. Do not report C1747 for Medicare claims in 2026.

C-codes are not all the same

• C9761 is a procedure code — it describes the service performed.
• C1747 is a device code for a single-use urinary tract endoscope. Its transitional pass-through payment ended December 31, 2025.

These codes are not substitutes for one another. Correct thinking is not “C9761 or C1747” but procedure code plus device code when applicable — based on site of service and payer rules.

Common scenarios

Scenario 1: Traditional ureteroscopy/lithotripsy with a single-use ureteroscope

• Facility: report CPT 52353/52356; report C1747 for HOPD when applicable.
• Physician: report the applicable CPT® code.

Scenario 2: CVAC procedure (steerable vacuum aspiration)

• Facility: report C9761 and applicable procedure charges. Report C1747 and applicable device charges in the HOPD. Do not report C1747 in the ASC for Medicare claims in 2026.
• Physician: report the applicable CPT® for the professional work — commonly 52353 or 52356.

Scenario 3: “There was suction” but no steerable vacuum aspiration catheter

• Facility: do not default to C9761 just because suction was used. Documentation must satisfy the full definition of C9761, including steerable vacuum aspiration via a steerable ureteral catheter.

ASC and HOPD diagnosis reporting: report ICD-10-CM codes that reflect the reason for the encounter/surgery and code to the highest level of specificity supported by the record.

Common kidney/ureter stone diagnosis codes include:

• N20.0 – Calculus of kidney
• N20.1 – Calculus of ureter
• N20.2 – Calculus of kidney with calculus of ureter

For outpatient surgery, first-list the diagnosis that is the reason for the surgery.

Documentation checklist: what must be present to support C9761

Facility coders should confirm the documentation supports all of the following:

• Cystourethroscopy with ureteroscopy and/or pyeloscopy was performed.
• Lithotripsy was performed, as applicable to the case.
• Ureteral catheterization for steerable vacuum aspiration was performed.
• A steerable ureteral catheter was used for simultaneous irrigation/aspiration per the C9761 descriptor.
• The operative note clearly indicates vacuum aspiration of stone fragments/debris from the kidney/collecting system — not just generic suction.
• The operative note includes mention of the actual device used, i.e., the CVAC System.

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Standardization tip

Standardize a short operative note phrase for surgeons to include when the CVAC procedure is performed:

“Steerable vacuum aspiration of the kidney/collecting system was performed using a steerable ureteral catheter (CVAC).”

Why claims fail

• Documentation says only “suction used.”
• The note does not support steerable vacuum aspiration.
• The actual device is not identified.
• Physician note, nursing record, supply log, and charge capture do not match.

Misinterpretations we see — and why they fail

• “The AMA said not to use C9761.”
  This fails because the AMA governs CPT® guidance for professional reporting; it does not issue facility OPPS HCPCS procedure coding rules.
• “C9761 is a device code, so we should bill C1747 instead.”
  This fails because C9761 is a procedure code describing the service, while C1747 describes a device item. They are not substitutes.
• “Any suction qualifies for C9761.”
  This fails because the C9761 descriptor requires steerable vacuum aspiration using a steerable ureteral catheter.

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Payment and edit considerations

• Packaging / pass-through status changes over time: C1747’s transitional pass-through payment ended December 31, 2025. Confirm current-year CMS status before relying on prior workflows.
• Claim edits and invoice requirements vary: validate edits, device lists, and submission requirements for the relevant year and payer. For Medicare OPPS/ASC claims, confirm current-year device pass-through lists, code edit tables, and any invoice submission requirements.
• Medicare vs commercial rules differ: private payer contracts may require different treatment of device code reporting. Consult payer contracts regarding whether C1747 is required when billing C9761 procedures.
• RCM coordination matters: when in doubt, validate with your payer and your facility’s internal revenue cycle and compliance teams.

Operational best practice

Add a short internal billing attestation or post-op coding checkpoint confirming the key C9761 elements, the actual device used, and whether the claim is HOPD or ASC.