Kidney Stone Coding and Documentation Overview

Accurate and thorough documentation is essential for appropriate coding and reimbursement when treating kidney stones. The following clinical details must be clearly documented to support medical necessity and guide the selection of the correct CPT and ICD-10 codes:

Key Documentation Elements

• Medical Necessity 

  Clearly define why the procedure was required (e.g., obstruction, recurrent stones, infection).

• Stone Size 

  Important for supporting the procedural approach and sometimes device used.

• Stone Location 

  • Kidney (renal pelvis/calyces)

  • Ureter (proximal, mid, distal)

• Surgical/Procedural Approach 

  Specify the technique used:

  • ESWL (Extracorporeal Shock Wave Lithotripsy) 

  • PCNL (Percutaneous Nephrolithotomy) 

  • Endoscopy (e.g., ureteroscopy with/without lithotripsy)

  • Pyeloscopy

• Stents (If Used) 

  Include if a stent was placed, exchanged, or removed, as this impacts coding and reimbursement.

 Product Specific Coding and Reimbursement Information

CVAC System   by Calyxo

Physician Coding

Common CPT Codes for Kidney Stone Coding

Shockwave Lithotripsy (ESWL)

Percutaneous Nephrolithotomy (PCNL)

Ureteroscopy with Laser Lithotripsy (Only one lithotripsy per side may be billed)

Manipulation, Basket Removal, or Vacuum

Insertion of an Indwelling Stent

Common ICD-10 Codes for Kidney Stone Coding     

 Other Considerations

• 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 full 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

    • These modifiers are necessary when a bilateral organ, such as the kidneys or ureters, is involved and a procedure is performed on only one side.

    • They are applied to unilateral procedures to differentiate between treatment on the left and right kidney or ureter.

• Global Period Awareness:

  • Most kidney stone procedures have a 90-day global period, related post-operative follow-ups are not billable unless complications requiring a return to the Operating/Procedure Room.