Urology billing is probably more difficult than other specialties. That’s because urology billing has challenges that are hard to deal with. More challenges mean more claim denials. In fact, according to a report by Becker’s ASC, urology practices and physicians have a denial rate of 17%. Surgical procedures that involve endoscopy or stent placement are especially prone to this issue.
CPT code 52332 represents one such procedure. According to data published by Becker’s ASC Review, code 52332 carries a 15 percent unexpected denial rate. This makes it the second most denied code in urology.
That’s why we have created this detailed guide on 52332. We will explain in detail what this code is, how you can use it properly, and some modifiers that you can use with it. So, let’s start.
CPT Code 52332 – Description
CPT code 52332 is defined as:
“Cystourethroscopy, with insertion of an indwelling ureteral stent (e.g., Gibbons or double-J type).”
The definition itself can be hard to understand. So, let’s simplify it. Code 52332 is a surgical urology code. Here’s what happens during the minor or minimally invasive surgery.
The surgeon passes a cystourethroscope (a thin tube-like camera with a light source) through the urethra and into the bladder. Using this scope, the physician then locates the ureteral orifice. Once it is located, they then pass a guidewire into the ureter and insert an indwelling stent over that wire. This stent is placed between the kidney and the bladder.
As per the Centers for Medicare & Medicaid Service’s (CMS’s) NCCI policy manual, chapter 7, an important point to note here is that in this procedure, the stent remains inside the patient, even after the operation. This is actually the defining feature of CPT code 52332. This means that a temporary stent, one that is placed and removed during the same operative session, does not qualify.
Appropriate Use Cases for CPT Code 52332
Here are some real-world scenarios in which CPT code 52332 can be used:
Ureteral Obstruction from a Kidney Stone
Suppose a patient comes to a practice with pain in his flank. He also has nausea and decreased urine output. The physician at the emergency department orders an imaging test. The results show ureteral calculus causing significant obstruction and early hydronephrosis. Now, since the stone is not amenable to spontaneous passage, the only option left is surgery.
So, the physician performs a cystourethroscopy. During the surgery, a guidewire is advanced past the stone, and a double-J stent is placed to bypass the obstruction. This helps in the passage of urine. The stent is left inside the body and is not removed at the end of surgery. So, in this case, the billing department can use CPT code 52332 to bill the procedure.
Ureteral Stricture Causing Partial Obstruction
For this scenario, suppose a patient comes with a progressively worsening ureteral stricture. It is restricting the passage of urine. This then indirectly causes frequent urinary tract infections. The physician tries to remedy the condition, but there is no positive effect. So, the surgeon then performs a cystourethroscopy and places an indwelling ureteral stent to maintain patency and relieve the partial obstruction while planning for a definitive repair.
In this scenario, the billing department can use CPT code 52332 to bill the surgery since all requirements are met.
Modifiers to Append with CPT Code 52332
The following modifiers are frequently used with CPT code 52332:
| Modifier | Name | When to Apply |
|---|---|---|
| 50 | Bilateral Procedure | Use when indwelling stents are placed in both the left and right ureter. |
| 51 | Multiple Procedures | Appended to the secondary procedure when multiple endoscopic procedures are performed in the same operative session. |
| LT | Left Side Procedure | Use when the stent is placed exclusively in the left ureter. |
| RT | Right Side Procedure | Use when the stent is placed exclusively in the right ureter. |
Reimbursement Guidelines for CPT Code 52332
Here are some additional guidelines that you should keep in mind while using CPT code 52332 in your claims:
Provide Detailed Documentation
Comprehensive documentation is your best defense against claim denials. A complete operative report for CPT 52332 should include:
- Clear clinical indication for the stent (e.g., obstruction, stricture, prophylactic use)
- Laterality (right ureter, left ureter, or bilateral)
- Stent type, size, and material
- Description of the technique used
- Confirmation of successful indwelling stent placement
- Any additional procedures performed
- Post-procedure care plan and follow-up instructions
- Physician signature and date of service
Consider Bundling Rules and NCCI Edits
CPT 52332 has several bundling restrictions that billers must know before submitting claims. Here are some:
- CPT 52332 and CPT 52005 are not separately reportable for the same ureter during the same patient encounter.
- CPT code 52332 cannot be used with codes 52320-52330, 52334-52355
Check Reimbursement Rate Before Submission
The Medicare reimbursement amount for CPT code 52332 varies for each Medicare Administrative Contractor (MAC) locality. However, the national average reimbursement amount for facility settings is $139.62 and $372.75 for non-facility settings.
You can check the exact amount for your MAC address via the PFS Lookup Tool.
Final Thoughts on CPT Code 52332
Let’s wrap up this guide. CPT code 52332 is one of the most billed and also one of the most denied codes in urology. To bill it correctly, you must understand the distinction between indwelling and temporary stents, apply the right laterality modifiers, and avoid unbundling errors.
However, even with all the billing guidelines at your disposal, urology billing can get frustrating. If your practice is experiencing frequent denials, consider getting help from specialized billing companies like NeuraBill. We offer premium urology billing services that are designed to reduce denials and boost your revenue collection.
