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CPT® Code 52356 refers to a specific medical procedure known as cystourethroscopy with ureteroscopy and/or pyeloscopy, which includes the use of lithotripsy and the insertion of an indwelling ureteral stent, such as a Gibbons or double-J type. This procedure is primarily performed to address urinary tract obstructions caused by calculi (stones) located in the ureters or renal pelvis. The process begins with the cleansing of the urethra using an antiseptic solution to minimize the risk of infection. A cystoscope, which can be either rigid or flexible, is then introduced through the urethra and into the bladder. To enhance visualization of the bladder wall, sterile saline may be instilled into the bladder. Once the bladder is inspected, the ureters are catheterized to facilitate access to the stones. A guidewire is carefully advanced through the cystoscope into the ureter, reaching the site of the calculus. Following this, a ureteroscope is advanced over the guidewire to the calculus site, where lithotripsy is employed to fragment the stone. This fragmentation can be achieved using either ultrasonic or electrohydraulic techniques, with the respective probe being advanced through the ureteroscope to generate shock waves that break the calculus into smaller pieces. After the stone is fragmented, a catheter is advanced over the guidewire to assist in flushing out the calculus fragments from the ureter and/or renal pelvis. The ureteroscope is then reintroduced to examine the renal pelvis and ureter before the placement of a stent. The stent is positioned in the ureter to ensure proper drainage and is left in place after the guidewire is removed. Finally, the cystoscope is used once more to inspect the bladder and confirm the correct positioning of the stent's distal tail before the procedure is concluded with the removal of the cystoscope. This comprehensive approach not only addresses the immediate issue of stone obstruction but also facilitates recovery and prevents future complications.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 52356 is indicated for the following conditions:
The procedure begins with the cleansing of the urethra using an antiseptic solution to reduce the risk of infection. Following this, a rigid or flexible cystoscope is introduced through the urethra and into the bladder. To enhance visualization of the bladder wall, sterile saline may be instilled into the bladder. Once the bladder is adequately filled, the physician inspects the bladder for any abnormalities. After the bladder inspection, the ureters are catheterized to gain access to the stones. A guidewire is then introduced through the cystoscope and advanced into the ureter, reaching the site of the calculus located in either the ureter or renal pelvis. Once the guidewire is in place, a ureteroscope is advanced over the guidewire to the site of the calculus. Lithotripsy is then performed to fragment the stone, which can be accomplished using either ultrasonic or electrohydraulic techniques. The respective probe is advanced through the ureteroscope to the calculus, where it is activated to generate shock waves that break the stone into smaller fragments. After the fragmentation process, the probe is withdrawn, and a catheter is advanced over the guidewire to assist in flushing out the calculus fragments from the ureter and/or renal pelvis. Following the irrigation, the catheter is removed, and the ureteroscope is again advanced through the ureter to the renal pelvis. The renal pelvis and ureter are carefully examined prior to the placement of a stent. As the ureteroscope is slowly withdrawn, a stent is advanced over the guidewire and positioned within the ureter to facilitate drainage. Once the guidewire is removed, leaving the stent in place, the cystoscope is used once more to inspect the bladder and confirm the position of the distal tail of the stent in the bladder. Upon completion of the procedure, the cystoscope is removed, concluding the intervention.
After the completion of the procedure, patients may be monitored for any immediate complications or adverse effects. It is common for patients to experience some discomfort or hematuria (blood in urine) following the procedure. The indwelling ureteral stent may remain in place for a specified duration, as determined by the physician, to ensure proper drainage and prevent obstruction. Patients are typically advised to follow up with their healthcare provider to assess the stent's position and function, as well as to evaluate for any potential recurrence of stones. Additional post-procedure care may include hydration recommendations and pain management strategies to facilitate recovery.
| Short Descr | CYSTO/URETERO W/LITHOTRIPSY | Medium Descr | CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | Long Descr | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) | 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 | 52351 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 |
| 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) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 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). | SG | Ambulatory surgical center (asc) facility service | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | CR | Catastrophe/disaster related | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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). | 56 | Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | GA | Waiver of liability statement issued as required by payer policy, individual case | GJ | "opt out" physician or practitioner emergency or urgent service | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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