Common professional CPT® codes

• 52353 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy.
• 52356 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent.

Important physician rule

• C9761 is not a physician professional claim code. It is a facility procedure code used by HOPDs and ASCs when supported by documentation and payer policy.
• Physicians should code based on the actual work performed: ureteroscopy/pyeloscopy, lithotripsy, stent placement, ureteral catheterization, stone manipulation/removal, biopsy, or other documented services.

Prior authorization practical point

• When authorization is required, make sure the professional authorization and facility authorization are aligned. The physician side may reference CPT® 52353 or 52356, while the facility side may require C9761.

Report diagnosis codes that reflect the reason for the encounter and code to the highest specificity supported by the medical record.

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

Additional diagnoses may be appropriate when supported by the record and relevant to medical necessity, operative complexity, payer policy, or patient risk.

Physician documentation should support the professional CPT® code and, when the facility reports C9761, should also support the facility’s C-code logic.

What the operative note should state clearly

• Procedure performed: cystourethroscopy with ureteroscopy and/or pyeloscopy, lithotripsy, stent placement if performed, and laterality.
• Device identification: the exact Pusen DISS™ Series single-use ureteroscope used: either DISS™ Series PRO V-1 or DISS™ Series PRO 7.5. The physician will know which scope was used and should document the exact name.
• Suction/vacuum aspiration: describe direct in-scope suction, irrigation/suction capability, and vacuum aspiration of stone fragments, dust, debris, or fluid.
• Steerability/catheter language: document that a steerable ureteral catheter/scope with suction capability was used when the facility intends to support C9761.
• Stone burden and outcome: location, size/burden, fragmentation, evacuation/aspiration, residual burden, complications, and follow-up plan.

Suggested claim-support phrase:
Procedure performed using the Pusen Direct In-Scope Suction (DISS) single-use ureteroscope with lithotripsy, suction/irrigation capabilities, and a steerable ureteral catheter for vacuum aspiration.

Modifier use

• Modifier -59 / -XS: may be required for distinct procedural services when payer rules allow. Do not report 52356 and 52353 on the same side simply by adding -59/-XS.
• Modifier -22: may be considered only when documentation supports substantially greater work than typical, with concrete detail such as increased operative time, difficult anatomy, unusually large stone burden, or extensive aspiration/evacuation work.
• Modifiers -LT / -RT / -50: use laterality and bilateral reporting according to payer-specific rules.

Global period awareness

• Most ureteroscopy stone procedures have a 0-day global period. Common exceptions include ESWL and PCNL procedures, which typically have 90-day globals.

Common physician-side pitfalls

• Generic language: “URS with suction” is too weak to support facility C9761 billing.
• Device omitted: failure to identify the Pusen DISS™ device weakens facility claim support.
• CPT/HCPCS role confusion: physicians report CPT® professional services; facilities report C-codes when applicable.
• Record mismatch: physician note, facility record, supply log, and charge capture must tell the same story.

The high-confidence rule: who bills what

• Physician / professional claim: report the applicable CPT® ureteroscopy/lithotripsy code, commonly 52353 or 52356. Physicians do not bill C9761.
• Facility (HOPD or ASC): report C9761 when all required elements are met and documented. PRS recommends obtaining written payer confirmation that C9761 is covered and retaining that documentation in your compliance records to help reduce future denial, recoupment, or clawback risk.
• Device code in the HOPD: for Medicare HOPD claims, report C1747 with the cost of the Pusen DISS™ device for tracking purposes. The expected Medicare payment on the C1747 line is $0 because payment is packaged.
• ASC limitation: do not report C1747 on Medicare ASC claims. Commercial payer rules may differ, so verify payer-specific instructions.

C9761 descriptor

C9761 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter).

When C9761 is supported for Pusen DISS™

• Services were provided in the HOPD or ASC.
• A Pusen DISS™ Series scope was used, and the documentation identifies the exact scope name: DISS™ Series PRO V-1 or DISS™ Series PRO 7.5.
• Either 52353 or 52356 work was performed.
• The physician documented that a steerable scope/catheter with suction capability was used to perform the procedure.

C9761 vs C1747

• C9761 = the procedure. It reports what was done and reflects facility resource utilization.
• C1747 = the device. It reports what was used: a single-use urinary tract endoscope.
• They are not substitutes. For Medicare, report C9761 and C1747 together only in the HOPD when documentation supports both; C1747 is reported with device cost for tracking and pays $0. Do not report C1747 in the ASC for Medicare. Commercial payer rules may differ.

ASC and HOPD outpatient 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.

• 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 best explains the encounter. Do not code probable, suspected, or rule-out diagnoses unless payer rules and official guidance allow.

Documentation checklist: what must be present to support C9761

• Cystourethroscopy with ureteroscopy and/or pyeloscopy was performed.
• Lithotripsy was performed.
• Ureteral catheterization for steerable vacuum aspiration was performed.
• The record identifies the exact Pusen DISS™ Series single-use ureteroscope used: either DISS™ Series PRO V-1 or DISS™ Series PRO 7.5.
• The operative note states that a steerable scope/catheter with suction capability was used.
• The record describes aspiration/evacuation of stone fragments, dust, debris, or fluid from the kidney/collecting system as applicable.

Claim remarks / internal billing note

Consider including this wording in Box 19 of the CMS-1500, FL 80 of the UB-04, or the internal billing note when supported by documentation and payer process:

Procedure performed using the Pusen Direct In-Scope Suction (DISS) single-use ureteroscope [insert exact scope name: DISS™ Series PRO V-1 or DISS™ Series PRO 7.5] with lithotripsy, suction/irrigation capabilities, and a steerable ureteral catheter for vacuum aspiration.

Record alignment

• Physician operative note, nursing documentation, supply log, device record, charge capture, and claim lines should all identify the same procedure and device story.
• Do not let the facility claim look like a C9761 procedure if the op note reads like ordinary URS with generic suction.

Payment and site-of-service considerations

• C1747 in the HOPD: for Medicare HOPD claims, report C1747 and the cost of the device for tracking purposes. The C1747 line is expected to pay $0 because payment is packaged.
• C1747 in the ASC: do not report C1747 on Medicare ASC claims. Commercial payer rules may differ.
• C9761 payment status: C9761 is device-intensive in the ASC and a comprehensive APC service in the HOPD under the 2026 framework reflected in the PRS payment guide.
• Payer variation: commercial and Medicare Advantage plans may apply different edits, authorization rules, device-code expectations, or invoice requirements.
• Written confirmation for C9761: before billing C9761, PRS recommends obtaining written payer confirmation that C9761 will be paid for the specific site of service and keeping that confirmation on file for compliance support in case of audit, claw-back, or take-back review.

Facility denial workflow

• Step 1: review the denial reason and confirm whether the claim, authorization, place of service, and documentation support the billed pathway.
• Step 2: correct what can be corrected. Confirm correct POS/site of service, exact Pusen DISS™ scope use (DISS™ Series PRO V-1 or DISS™ Series PRO 7.5), physician code 52353 or 52356, and documentation of a steerable scope with suction capability.
• Step 3: check Box 19 or UB-04 FL 80 remarks for the DISS wording when appropriate; correct and appeal if needed.
• Second denial: contact PRS using the DISS denial support process.

Common facility-side pitfalls

• Billing C9761 without the full descriptor: suction alone is not enough.
• Missing device identity: claim references DISS but the record does not identify the exact Pusen DISS™ scope used: DISS™ Series PRO V-1 or DISS™ Series PRO 7.5.
• C9761/C1747 substitution error: treating the procedure code and device code as alternatives rather than distinct claim elements, or reporting C1747 on Medicare ASC claims when it should only be reported for Medicare tracking in the HOPD.
• Record mismatch: physician note, nursing documentation, supply log, chargemaster, and claim lines do not align.