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Official Description

Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

CPT® Code 52325 refers to a specific medical procedure known as cystourethroscopy, which includes the process of ureteral catheterization and the fragmentation of a ureteral calculus. This procedure is performed to address the presence of stones located in the ureter, which can cause significant discomfort and complications if not treated. The term 'cystourethroscopy' indicates that the procedure involves the examination of the bladder and urethra using a cystoscope, a specialized instrument that allows for direct visualization. The procedure begins with the cleansing of the urethra using an antiseptic solution to minimize the risk of infection. A rigid or flexible cystoscope is then inserted through the urethra into the bladder, where the bladder may be filled with sterile saline to enhance the visibility of the bladder wall. Following the inspection of the bladder, the ureters are catheterized to facilitate access to the ureteral stone. The fragmentation of the calculus is achieved using either ultrasonic or electrohydraulic techniques, which involve the application of shock waves to break the stone into smaller, more manageable pieces. This allows for easier retrieval of the stone fragments, which can then be irrigated from the ureter. The procedure concludes with the removal of the cystoscope, guidewire, and any catheters used during the process, ensuring that the patient is left in a stable condition post-procedure.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 52325 is indicated for the treatment of ureteral calculi, which are stones that form in the ureters. These stones can lead to various symptoms and complications, necessitating intervention. The following conditions may warrant the performance of this procedure:

  • Ureteral Calculus The presence of stones in the ureter that may cause obstruction, pain, or urinary complications.
  • Hematuria The presence of blood in the urine, which may be associated with ureteral stones.
  • Flank Pain Severe pain in the side and back, often indicative of a stone obstructing the urinary tract.
  • Urinary Tract Infection Recurrent infections that may be linked to the presence of stones in the urinary system.

2. Procedure

The procedure for CPT® Code 52325 involves several critical steps to ensure the effective fragmentation and removal of the ureteral calculus. Each step is essential for the successful outcome of the procedure:

  • Step 1: Preparation The patient is positioned appropriately, and the urethra is cleansed with an antiseptic solution to reduce the risk of infection during the procedure.
  • Step 2: Cystoscope Insertion A rigid or flexible cystoscope is introduced through the urethra into the bladder. This instrument allows the physician to visualize the bladder and urethra directly.
  • Step 3: Bladder Filling The bladder may be filled with sterile saline to enhance visualization of the bladder wall and facilitate the identification of any abnormalities.
  • Step 4: Ureteral Catheterization After inspecting the bladder, the ureters are catheterized to gain access to the ureteral stone. A guidewire is then introduced through the cystoscope and advanced through the ureter into the renal pelvis.
  • Step 5: Fragmentation of Calculus An ultrasonic or electrohydraulic probe is advanced through the cystoscope to the location of the ureteral stone. The probe is activated, generating shock waves that fragment the calculus into smaller pieces.
  • Step 6: Retrieval of Fragments Following the fragmentation, a retrieval device may be used to capture the stone fragments. The ureter may also be irrigated to remove any remaining calculus fragments.
  • Step 7: Catheter Placement A catheter may be advanced over the guidewire into the renal pelvis to facilitate drainage and further irrigation if necessary.
  • Step 8: Completion Upon completion of the procedure, the cystoscope, guidewire, and any catheters used are carefully removed, ensuring that the patient is stable before concluding the procedure.

3. Post-Procedure

After the completion of the procedure, patients may require monitoring for any immediate complications. Post-procedure care typically includes ensuring that the patient is stable and managing any discomfort. Patients may experience some degree of pain or hematuria following the procedure, which is generally expected. Instructions for hydration and monitoring for signs of infection or complications will be provided. Follow-up appointments may be necessary to assess recovery and ensure that any remaining stone fragments have been adequately managed.

Short Descr CYSTOSCOPY STONE REMOVAL
Medium Descr CYSTO FRAGMENTATION URETERAL STONE
Long Descr Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 3 - Special payment adjustment rules for multiple endoscopic procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code 52000  Cystourethroscopy (separate procedure)
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P8E - Endoscopy - cystoscopy
MUE 1
CCS Clinical Classification 101 - Transurethral excision, drainage, or removal urinary obstruction
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
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2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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