General concept: Choose CPT based on what you did (ureteroscopy/pyeloscopy, lithotripsy, stent, etc.). C8014 and C9761 are facility codes — physicians do not report them.

Common ureteroscopy/lithotripsy codes (examples)

• 52353 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)
• 52356 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

Reporting the additional suction/aspiration work

• For the additional work associated with suction-assisted fragment evacuation, physicians may consider modifier -22 (increased procedural services) appended to 52353/52356, or the unlisted code 53899 (unlisted procedure, urinary system), when documentation supports it.
• A short description of the extra work performed should be added to Box 19 of the claim (or the EDI equivalent) to assist payer processing.

Documentation language that helps:

• State lithotripsy performed (laser, etc.).
• Stent usage (placed vs not placed; laterality if relevant).
• Describe stone burden/location and outcome (residual fragments, stone-free intent, etc.).
• Describe aspiration/evacuation workflow (e.g., suction via access sheath system) clearly, scope size and type/make — the facility code (C8014 vs C9761) turns on whether the scope itself is suction-integrated.

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

Documentation should include a clear and accurate clinical description of the procedure performed and the name(s) of the device(s) used.

New for Q3 2026: because the facility code now depends on the equipment combination, the operative note should state (1) the scope type (suction-integrated or standard), and (2) that a suction-enabled ureteral access sheath (HOOVER FANS) was used, with irrigation if performed.

• 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 is used when a procedure requires significantly more effort than usual.

    Example of Modifier 22 in Practice

    Scenario: Steerable Ureteroscopy with Suction Technology

    Standard procedure: Breaking stones with laser, relying on natural clearance.

    Enhanced procedure: Using suction to actively remove stone fragments, requiring additional laser work and extended scope manipulation.

    Documentation: "The procedure required 2 times the amount of operative time than the normal time to ensure a completely clear the kidney due to the number of stones, the structure of the stones resulting in irregular fracture and the anatomy of the kidney. Additional operative time was required to fully explore and evacuate stone burden, reducing post-op complications and risk of repeat stone formation."

    Justification: This extra effort places the procedure in the statistical 'tail' of the standard bell curve, warranting higher reimbursement.

  • Modifiers -LT and -RT
    • Are required when a bilateral organ, such as the kidneys or ureters, is involved and a procedure is performed on only one side.
    • Are applied to unilateral procedures to differentiate between treatment on the left and right kidney or ureter.
  • Modifier -50 Bilateral
    • Use when identical service is provided on both the right and left during the same encounter.
    • Report "1" unit when using modifier -50 per current ANSI standards; fee may be increased to support expected increase in reimbursement.
    • Some payers may require alternative reporting including use of 2 lines with RT and LT on separate lines.
    • Check with payer for appropriate bilateral reporting.

• Global Period Awareness

  • Most kidney stone procedures have a 0-day global period. (Exceptions are the ESWL and PCNL procedures which have 90-day global periods.)

• Common Physician-Side Pitfalls

  • Underspecifying the work: "URS with suction" without clarifying lithotripsy, renal vs ureteral location, or outcome.
  • Scope-type ambiguity: the op note does not say whether the ureteroscope was suction-integrated — the facility cannot pick between C8014 and C9761 without it.
  • Stent ambiguity: stent placed but not clearly documented (or vice versa).
  • Inconsistent terminology: shorthand in the op note that doesn't map to clean claims language.
  • Assuming facility edits don't affect you: facility denials often trigger rebilling cycles and physician AR delays.

How to choose: the equipment combination drives the facility procedure code.

Procedure codes

• C8014 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy, including use of a suction enabled ureteral access sheath, with irrigation (if performed). HOOVER FANS with a standard scope.
• 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 or suction-integrated ureteroscope). Suction-integrated scope, with or without HOOVER FANS.
• 52353 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included).
• 52356 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type).

Device code (report per site-of-service rules below)

• C1747 – Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable) — report only when a single-use scope is part of the case. Packaged payment.

Site of Service: What Drives Facility Payment

• HOPD (Outpatient Hospital): C8014 is assigned to the same APC level as 52353/52356 (approx. $5,478 national average, Q3 2026); C9761 is assigned one level higher (approx. $9,672). Status indicator J1 — all covered Part B services are packaged with the primary service. Report C1747 with your charges when a single-use scope is used; it pays $0 but supports future rate setting. If no single-use scope was used, do not report C1747.
• ASC: C8014 (approx. $3,452) and C9761 (approx. $6,612) are device-intensive (payment indicator J8); 52353/52356 pay approx. $2,730. Report C8014; C1747 is not required on Medicare ASC claims and may cause rejections or invoice requests from some MACs. Check payer-specific instructions.
• Commercial payers: may not have loaded C8014 yet; confirm policy/contract support or default to the supported code per payer instruction.

Charge Capture Tips: Common Misses That Trigger Denials

• Reporting C8014 and C9761 together: both are J1/primary — report only one per case.
• Missing C1747 on HOPD claims: when a single-use scope is used, report C1747 with your device charges; if no single-use scope was used, do not report C1747.
• C1747 on Medicare ASC claims: not required and may trigger rejections or invoice requests from some MACs — check payer-specific instructions.
• Op note does not identify the scope type: without it, C8014 vs C9761 selection cannot be supported.

ASC and HOPD (outpatient) diagnosis reporting: Report ICD-10-CM diagnosis codes that reflect the reason for the encounter/surgery and code to the highest level of specificity supported by the medical record (use all applicable characters; include laterality/associated conditions when available). In the outpatient setting, the first-listed diagnosis is used in lieu of an inpatient "principal diagnosis."

For outpatient surgery (same-day surgery), code the reason for the surgery as the first-listed diagnosis even if the procedure is not performed due to a contraindication. If a definitive diagnosis is not established, do not code "probable/suspected/rule out" conditions—code the signs/symptoms or the condition(s) actually confirmed, and report additional diagnoses that affect care as secondary diagnoses.

Common Kidney/Ureter ICD-10 Codes:

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

What must be present to support C8014

• Cystourethroscopy with ureteroscopy and/or pyeloscopy was performed.
• Lithotripsy was performed.
• A suction-enabled ureteral access sheath (HOOVER FANS) was used, with irrigation if performed.
• The ureteroscope used was a standard (non-suction-integrated) scope — if a suction-integrated scope was used, C9761 applies instead.
• The record names the device: Dornier HOOVER FANS.

Suggested claim-support phrase:
Procedure performed using a [standard/single-use] ureteroscope with laser lithotripsy and the Dornier HOOVER FANS flexible and navigable suction ureteral access sheath for irrigation and aspiration of stone fragments and dust.

Facility Documentation: What to Capture

To reduce denials and rework, ensure the facility record clearly captures:

• Procedure elements: cystourethroscopy + ureteroscopy/pyeloscopy + lithotripsy performed (as applicable).
• Stone location/burden and outcomes: renal pelvis/calyces involvement and clearance intent.
• Fragment evacuation: clear statement of fragment evacuation/aspiration workflow (e.g., active suction via access sheath system).
• Scope identification: scope make/type and whether it is suction-integrated — this drives C8014 vs C9761.
• Stent status: placed vs not placed; laterality and device specifics per facility policy.
• Device/supply capture: HOOVER FANS device/supply documentation should match the supply log and charge capture record.
• Record alignment: physician op note + nursing + supply + charge master match the same story.

Why this matters: when records tell different stories, payers default to denial or downcoding.

Coverage & Policy Notes

• New-code adoption risk: C8014 is effective July 1, 2026. Some commercial payers, Medicare Advantage plans, and clearinghouse edits may lag. Confirm the code is loaded and payable before converting your chargemaster.
• Code-selection risk: billing C9761 when the scope was not suction-integrated (or C8014 when it was) is a mismatch auditors can spot from the op note. The scope type must be documented.
• Device-code direction is site-specific: HOPD — report C1747 with charges when a single-use scope was used (packaged, $0 separate payment, supports future rate setting); do not report C1747 if no single-use scope was used. ASC — C1747 is not required for Medicare and may cause rejections or invoice requests from some MACs. Check payer-specific instructions.
• Audit and takeback risk: high-dollar and new-technology claims are frequent targets for review. Initial payment does not guarantee long-term retention of funds.

Practical documentation protections (what helps in the real world)

• Be explicit in the facility record: describe the aspiration workflow (where it occurred—renal pelvis/calyces, what was aspirated—fragments/dust/fluid, and how suction was applied/controlled). Include devices used during the procedure.
• Align every record: physician op note, nursing documentation, supply log, and charge capture should all tell the same procedural story.
• Consider a brief claim or internal narrative: some facilities add a short explanatory note describing the suction-enabled access sheath workflow, which can help demonstrate transparency if the claim is later reviewed.

Charge Capture Tips: Common Misses That Trigger Denials

• Vague "suction" wording: doesn't support the full procedure narrative (and can create inconsistencies across records).
• Supply not documented: charge posted but not supported by the clinical record or supply log.
• Procedure mismatch: facility record reads like standard URS while other documentation implies different work elements.
• Assuming payer parity: commercial policies may not mirror Medicare outpatient treatment.

Operational best practice: add a brief post-op "billing attestation" line confirming the key performed elements and supplies used.