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. The same is true of C8014 and of device codes C1747 and C1889.
• 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: PUSEN DISS® 6.3, PUSEN DISS® 7.5, or PUSEN DISS® 9.2. The physician will know which scope was used and should document the exact name.
• Sheath, when used: if a suction-enabled ureteral access sheath such as PUSEN ClearEVAC™ was also used, name it.
• Stone burden and outcome: location, size/burden, fragmentation, evacuation/aspiration, residual burden, complications, and follow-up plan.

Helpful Hint — operative note documentation

The surgeon’s operative note should name the PUSEN DISS® scope used. This language belongs in the operative note only; it does not need to be added to Box 19 of the CMS-1500 or FL 80 of the UB-04.

PUSEN DISS® used alone (C9761):
“Procedure performed using the Pusen DISS® [PUSEN DISS® 6.3, PUSEN DISS® 7.5, PUSEN DISS® 9.2] single-use ureteroscope with suction/irrigation capabilities.”

PUSEN DISS® used with the ClearEVAC™ sheath (Medicare HOPD: C9761, C1747, and C1889; do not report C8014):
“Procedure performed using the Pusen DISS® [PUSEN DISS® 6.3, PUSEN DISS® 7.5, PUSEN DISS® 9.2] single-use ureteroscope with suction/irrigation capabilities and ClearEVAC™ sheath.”

Generic language such as “suction used” does not identify the device. Name the scope model (and the ClearEVAC™ sheath, when used) so the note supports the facility code reported.

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 for the DISS® procedure when all required elements are met and documented.
• Device codes in the HOPD: for Medicare HOPD claims, report C1747 for the Pusen DISS® scope (and C1889 if a suction-enabled ureteral access sheath is also used) with your device charge amounts. The expected Medicare payment on these device lines is $0 because payment is packaged.
• ASC limitation: do not report C1747 or C1889 on Medicare ASC claims. Commercial payer rules may differ, so verify payer-specific instructions.

C9761 descriptor (revised by CMS effective July 1, 2026)

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 necessary, with use of steerable ureteral catheter or suction-integrated ureteroscope

When C9761 is supported for Pusen DISS®

• Services were provided in the HOPD or ASC.
• A Pusen DISS® Series scope (a suction-integrated ureteroscope) was used, and the documentation identifies the exact scope name: PUSEN DISS® 6.3, PUSEN DISS® 7.5, or PUSEN DISS® 9.2.
• Either 52353 or 52356 work was performed.

C8014 (effective July 1, 2026) — not used with a DISS® scope

C8014 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, including use of a suction enabled ureteral access sheath, with irrigation (if performed)

• C8014 is reported by the facility when a standard reusable or disposable (non-suction-integrated) ureteroscope is used with a suction-enabled ureteral access sheath.
• C8014 is not used with a DISS® scope. When a DISS® scope is used, with or without a sheath, the facility procedure code is C9761.
• C9761 and C8014 are never reported together on the same claim. The scope and suction device documented in the operative note determine which code is reported.

DISS® used with the PUSEN ClearEVAC™ sheath

• Procedure code: C9761 (not C8014).
• Medicare HOPD device lines: C1747 (DISS® scope) and C1889 (ClearEVAC™ sheath) with device charge amounts; packaged, $0.
• Medicare ASC: no device codes.
• Commercial: the payer may require or pay separately for C1747 and C1889 and may require revenue code 0278; check with your payer.

C9761 vs C1747 vs C1889

• C9761 = the procedure. It reports what was done and reflects facility resource utilization.
• C1747 = the single-use ureteroscope. It reports the device used: a single-use urinary tract endoscope.
• C1889 = the suction-enabled access sheath (when used). Implantable/insertable device, not otherwise classified.
• They are not substitutes. For Medicare, report the device codes with C9761 only in the HOPD when documentation supports them; they are reported with device charges for tracking and pay $0. Do not report C1747 or C1889 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.
• The operative note names the exact Pusen DISS® Series single-use ureteroscope used: PUSEN DISS® 6.3, PUSEN DISS® 7.5, or PUSEN DISS® 9.2.
• If a suction-enabled ureteral access sheath such as PUSEN ClearEVAC™ was also used, the operative note names it.

Helpful Hint — operative note documentation

The surgeon’s operative note should name the PUSEN DISS® scope used. This language belongs in the operative note only; it does not need to be added to Box 19 of the CMS-1500 or FL 80 of the UB-04.

PUSEN DISS® used alone (C9761):
“Procedure performed using the Pusen DISS® [PUSEN DISS® 6.3, PUSEN DISS® 7.5, PUSEN DISS® 9.2] single-use ureteroscope with suction/irrigation capabilities.”

PUSEN DISS® used with the ClearEVAC™ sheath (Medicare HOPD: C9761, C1747, and C1889; do not report C8014):
“Procedure performed using the Pusen DISS® [PUSEN DISS® 6.3, PUSEN DISS® 7.5, PUSEN DISS® 9.2] single-use ureteroscope with suction/irrigation capabilities and ClearEVAC™ sheath.”

Generic language such as “suction used” does not identify the device. Name the scope model (and the ClearEVAC™ sheath, when used) so the note supports the facility code reported.

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 / C1889 in the HOPD: for Medicare HOPD claims, report C1747 (and C1889 if a suction-enabled access sheath is used) with your device charge amounts for tracking purposes. These device lines are expected to pay $0 because payment is packaged.
• C1747 / C1889 in the ASC: do not report C1747 or C1889 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 C9761.
• Step 2: correct what can be corrected. Confirm the correct POS/site of service, the PUSEN DISS® model named in the operative note (PUSEN DISS® 6.3, PUSEN DISS® 7.5, or PUSEN DISS® 9.2), physician code 52353 or 52356, and device-code reporting appropriate to the site of service (Medicare HOPD: C1747, and C1889 if a sheath is used; Medicare ASC: none).
• Step 3: confirm the payer recognizes C9761; if the payer does not, rebill with 52353/52356 per payer instruction. Correct and appeal as needed.
• Second denial: contact PRS using the DISS® denial support process at prsnetwork.com/dissdenial.

Common facility-side pitfalls

• Billing C9761 without device identity: “suction used” alone is not enough; the operative note must name the DISS® scope.
• Missing device identity: claim references DISS® but the record does not identify the exact Pusen DISS® scope used: PUSEN DISS® 6.3, PUSEN DISS® 7.5, or PUSEN DISS® 9.2.
• Reporting C8014 with a DISS® scope: C8014 applies only when a suction-enabled sheath is used with a standard (non-suction-integrated) ureteroscope, and it is never reported with C9761.
• C9761/device-code substitution error: treating the procedure code and device codes as alternatives rather than distinct claim elements, or reporting C1747 or C1889 on Medicare ASC claims when they 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.