Crystal's MCW Coder Hub👩🏾⚕️CPT Code 52352 - Cystourethroscopy with Ureteroscopy and/or Pyeloscopy; with Removal or Manipulation of Calculus
Full CPT Description: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
📋 Procedure Overview
CPT 52352 describes a combined endoscopic procedure in which the surgeon passes a rigid or flexible ureteroscope transurethrally through the bladder and into the ureter and/or renal pelvis (pyeloscopy) to either physically remove or manipulate a calculus (stone). Manipulation includes basket extraction, forceps grasping, or repositioning of a stone to facilitate passage or subsequent treatment. Because ureteroscopy inherently requires placement of a ureteral catheter for access and visualization, ureteral catheterization is bundled into this code and may not be billed separately.
This is a therapeutic endoscopic procedure of the upper urinary tract and represents a step above diagnostic ureteroscopy (52351) but a step below laser/ultrasonic lithotripsy (52353). It is one of the most commonly performed urologic procedures for urolithiasis management and is applicable whether the stone resides in the ureter (proximal, mid, or distal) or within the renal pelvis.
⚙️ Procedural Mechanics
The procedure typically follows this sequence:
- Cystoscopy is performed first (bundled, cannot bill 52000 separately).
- A guide wire is passed under fluoroscopic or direct vision into the ureteral orifice and advanced to the renal pelvis.
- A ureteroscope (rigid or flexible) is advanced over or alongside the guide wire into the ureter or renal pelvis.
- The calculus is identified, and the surgeon uses a basket (e.g., Nitinol tipless basket, zero-tip basket) or forceps to capture and extract the stone intact, OR the stone is manipulated to push it retrograde into the renal pelvis for spontaneous passage or future ESWL.
- A ureteral stent (52332) may be placed at the conclusion if warranted — this may be separately reportable depending on payer policy (see Coding Nuances below).
💰 Reimbursement & RVU Data
| Component | Value (Approximate - Verify Current Year CMS MPFS)1 |
|---|---|
| Work RVU (wRVU) | 7.26 |
| Non-Facility Total RVU | ~13.61 |
| Facility Total RVU | ~10.04 |
| Global Period | 000 (Zero-day global) |
| Assistant Surgeon Payable | ❌ No (Indicator: 0 - Medicare; verify commercial) |
| Bilateral Surgery Indicator | 3 - Cannot be bilateral (endoscopic, naturally unilateral per session) |
| Co-Surgeon | ❌ Not applicable |
| Team Surgery | ❌ Not applicable |
⚠️ wRVU Note: Values fluctuate annually with CMS MPFS updates. Always verify against the current year’s CMS Physician Fee Schedule Look-Up Tool. The values above reflect recent published schedules and should be confirmed for the applicable year.1
✅ Includes (Bundled - Do Not Bill Separately)
The following services are inherently included in 52352 and are not separately reportable:
- Ureteral catheterization - explicitly stated in the code descriptor
- Cystoscopy / cystourethroscopy (52000) - endoscopic access is required to reach the ureter
- Fluoroscopic guidance - when used intraoperatively during standard ureteroscopy (not separately billable in most circumstances)
- Irrigation and dilation of the ureter to allow scope passage
- Diagnostic component - 52351 (diagnostic ureteroscopy) is bundled when therapeutic removal/manipulation is performed in the same session
🚫 Excludes / Cannot Bill Together (NCCI Edits & Bundling)
The following codes are subject to NCCI bundling edits with 52352 and generally cannot be billed on the same date without a valid modifier exception:2
| Bundled Code | Description | Modifier Allowed? |
|---|---|---|
| 52000 | Cystourethroscopy | ❌ No |
| 52005 | Cystoscopy with ureteral catheterization | ❌ No |
| 52351 | Diagnostic ureteroscopy | ❌ No |
| 52353 | Ureteroscopy with lithotripsy | See note below |
| 52356 | Ureteroscopy with lithotripsy + stent | ❌ No (mutually exclusive) |
| 76000 | Fluoroscopy, up to 1 hour | ❌ Typically bundled |
| 74420 | Urography, retrograde | Payer-specific |
52352 vs. 52353 Conflict: If a stone is first manipulated and then subjected to in-situ lithotripsy in the same session, only 52353 is reported. The manipulation is considered preparatory to lithotripsy and does not constitute a separately billable service. Do not report 52352 and 52353 together for the same stone/same session.
Stent Placement (52332): If a ureteral stent is placed at the conclusion of 52352, some payers allow separate billing of 52332 with modifier -59 (or -XS for distinct structural service). This is highly payer-dependent — Medicare and many commercial payers bundle stent placement post-ureteroscopy. Always verify with the specific payer’s NCCI or LCD.
🌳 Code Tree - Ureteroscopy / Pyeloscopy Family
Cystourethroscopy with Ureteroscopy and/or Pyeloscopy
│
├── 52351 - Diagnostic ureteroscopy and/or pyeloscopy (no therapeutic intervention)
│
├── 52352 ◄ THIS CODE - With removal or manipulation of calculus
│ (ureteral catheterization included)
│
├── 52353 - With lithotripsy (laser, ultrasonic, electrohydraulic)
│ (ureteral catheterization included)
│
├── 52354 - With biopsy and/or fulguration of urothelium of upper urinary tract
│
├── 52355 - With resection of ureteral or pelvic tumor
│
└── 52356 - With lithotripsy INCLUDING insertion of indwelling ureteral stent
(ureteral catheterization included)
Parent Cystoscopy-Level Stone Codes (Lower Urinary Tract - Ureter Distal)
Cystourethroscopy (including ureteral catheterization)
│
├── 52320 - With removal of ureteral calculus (distal ureter via cystoscope only)
├── 52325 - With fragmentation of ureteral calculus
└── 52330 - With manipulation, without removal of ureteral calculus
🔑 Tip for Coders: 52320-52330 are reserved for cases where the ureteroscope is NOT passed beyond the ureteral orifice — the procedure is done via cystoscope alone. If the scope is advanced into the ureter itself (ureteroscopy), use the 52351-52356 family.
🏥 ICD-10-CM Diagnosis Codes Commonly Paired with 52352
Primary Diagnoses
| ICD-10-CM Code | Description | HCC Mapped? | HCC Category |
|---|---|---|---|
| N20.1 | Calculus of ureter | ❌ No | — |
| N20.0 | Calculus of kidney | ❌ No | — |
| N20.2 | Calculus of kidney with calculus of ureter | ❌ No | — |
| N13.2 | Hydronephrosis with renal and ureteral calculous obstruction | ❌ No | — |
| N13.6 | Pyonephrosis | ❌ No | — |
| N21.0 | Calculus in bladder | ❌ No | — |
HCC Note: Urinary calculi codes (N20.0, N20.1, N20.2) are not mapped to HCC under either CMS-HCC v24 or v28 models. These are episodic, treatable conditions and do not carry risk-adjustment value. However, comorbidities documented at the same encounter — such as CKD, diabetes, or sepsis — may carry significant HCC weight and must be coded when documented and clinically relevant.
High-Value Comorbidity / Complication ICD-10-CM Codes (HCC-Relevant)
| ICD-10-CM Code | Description | HCC v24 | HCC v28 |
|---|---|---|---|
| N18.3- | Chronic kidney disease, stage 3 (also 3a/3b) | HCC 137 | HCC 329 |
| N18.4 | Chronic kidney disease, stage 4 | HCC 137 | HCC 329 |
| N18.5 | Chronic kidney disease, stage 5 | HCC 136 | HCC 328 |
| N18.6 | End stage renal disease | HCC 136 | HCC 328 |
| A41.9 | Sepsis, unspecified organism | HCC 2 | HCC 2 |
| A41.51 | Sepsis due to Escherichia coli | HCC 2 | HCC 2 |
| E11.65 | T2DM with hyperglycemia | HCC 19 | HCC 37 |
| E11.649 | T2DM with hypoglycemia without coma | HCC 19 | HCC 37 |
| N39.0 | Urinary tract infection, site not specified | ❌ No | — |
| B37.49 | Other urogenital candidiasis | ❌ No | — |
⚠️ Coding Compliance Reminder: HCC-eligible diagnoses must be documented, clinically relevant, and evaluated/treated or monitored during the encounter to be coded. Do not code conditions that are not addressed or referenced in provider documentation for that encounter.3
Procedure-Related Complication Codes
| ICD-10-CM Code | Description |
|---|---|
| N99.89 | Other postprocedural complications of genitourinary system |
| N13.5 | Crossing vessel and stricture of ureter without hydronephrosis |
| R31.9 | Hematuria, unspecified |
| R31.0 | Gross hematuria |
| S37.19XA | Other injury of ureter, initial encounter |
| T83.598A | Infection/inflammatory reaction due to other prosthetic device, implant, and graft in urinary system |
🏨 MS-DRG Assignment
Important Distinction for Inpatient Coders: CPT codes are used for physician/professional billing and outpatient hospital billing. For inpatient facility billing, ICD-10-PCS procedure codes drive DRG assignment, not CPT codes. The ICD-10-PCS equivalents for ureteroscopic stone removal are listed below. MS-DRGs are assigned based on principal diagnosis + ICD-10-PCS procedures + CC/MCC status.
Relevant MS-DRGs (MDC 11 - Diseases & Disorders of the Kidney & Urinary Tract)
| MS-DRG | Description | Avg. LOS | Relative Weight (approx.)4 |
|---|---|---|---|
| 693 | Urinary Stones w/ Other O.R. Procedure w/ MCC | ~4.2 days | ~1.8 |
| 694 | Urinary Stones w/ Other O.R. Procedure w/ CC | ~2.6 days | ~1.1 |
| 695 | Urinary Stones w/ Other O.R. Procedure w/o CC/MCC | ~1.7 days | ~0.85 |
| 696 | Urinary Stones w/o O.R. Procedure w/ MCC | ~4.0 days | ~1.2 |
| 697 | Urinary Stones w/o O.R. Procedure w/ CC | ~2.4 days | ~0.74 |
| 698 | Urinary Stones w/o O.R. Procedure w/o CC/MCC | ~1.5 days | ~0.55 |
DRGs 693-695 are triggered when urinary calculus is the principal diagnosis AND an OR procedure (e.g., ureteroscopy) is performed. DRGs 696-698 apply when the patient is managed medically without a qualifying OR procedure.
If sepsis (A41.9) or urosepsis complicates the admission and is the principal diagnosis, the case may shift to MDC 18 (Infectious & Parasitic Diseases) with significantly higher DRG weights. Principal diagnosis selection in these cases requires careful review of UHDDS guidelines and Coding Clinic guidance.3
ICD-10-PCS Equivalents (Inpatient Facility Billing)
The root operation for ureteroscopic stone removal is Extirpation (C) — “taking or cutting out solid matter from a body part.”
| ICD-10-PCS Code | Description |
|---|---|
| 0TC67ZZ | Extirpation of matter from right ureter, via natural or artificial opening endoscopic |
| 0TC77ZZ | Extirpation of matter from left ureter, via natural or artificial opening endoscopic |
| 0TC87ZZ | Extirpation of matter from bilateral ureters, via natural or artificial opening endoscopic |
| 0TC37ZZ | Extirpation of matter from right kidney pelvis, via natural or artificial opening endoscopic |
| 0TC47ZZ | Extirpation of matter from left kidney pelvis, via natural or artificial opening endoscopic |
If manipulation only (stone repositioned, not removed), the root operation may be Reposition (S) rather than Extirpation. Document review is essential. The approach is always 7 - Via Natural or Artificial Opening Endoscopic for ureteroscopy.
🏷️ Modifiers Applicable to 52352
| Modifier | Description | Use Case |
|---|---|---|
| -LT | Left side | Stone in left ureter or left renal pelvis |
| -RT | Right side | Stone in right ureter or right renal pelvis |
| -22 | Increased procedural services | Unusually complex procedure (impacted stone, severe tortuosity, multiple stones); requires documentation supporting increased work and often a written note addendum |
| -51 | Multiple procedures | When multiple distinct endoscopic procedures are performed; subject to multiple procedure reduction (typically 50% reduction on secondary code) |
| -52 | Reduced services | Procedure begun but not completed (e.g., stone not accessible; basket deployment only) |
| -53 | Discontinued procedure | Procedure terminated after initiation due to risk to patient |
| -59 | Distinct procedural service | Used when billing 52332 (stent) separately from 52352 to indicate it was a distinct service; payer-dependent |
| -XS | Separate structure (HCPCS X-modifier) | Alternative to -59 for some payers; preferred by some MACs |
Bilateral Note: 52352 cannot be reported as a bilateral procedure (indicator 3). If stones are addressed in both ureters in the same operative session, report 52352 twice with -LT and -RT respectively, and apply modifier -51 to the second code. Some payers may bundle — verify.
📖 Coding Examples
Example 1 - Straightforward Ureteral Stone Extraction
A 47-year-old male presents with acute left flank pain and CT confirms a 7mm obstructing stone at the left ureterovesical junction (UVJ). The urologist performs cystourethroscopy, advances a flexible ureteroscope into the left ureter, and extracts the stone intact using a Nitinol basket. No stent is placed.
CPT: 52352--LT ICD-10-CM: N20.1
Example 2 - Stone Manipulation into Renal Pelvis
A 62-year-old female with a 9mm mid-ureteral stone (right) undergoes ureteroscopy. The stone is encountered but cannot be safely basketed due to impaction. The surgeon successfully manipulates the stone retrograde into the renal pelvis for future ESWL. The procedure is documented as “manipulation of calculus.”
CPT: 52352--RT ICD-10-CM: N20.1
✅ “Removal OR manipulation” — manipulation alone satisfies the code descriptor.
Example 3 - Ureteroscopy with Stone Extraction + Stent Placement
A 55-year-old male undergoes left ureteroscopy for a 1.1 cm proximal ureteral stone. Stone is basketed and removed. Given the degree of ureteral edema and proximal location, a 6-Fr double-J ureteral stent is placed at the conclusion of the procedure.
CPT (Option A - Bundled, most conservative): 52352--LT CPT (Option B - Separate stent, payer-dependent): 52352--LT, 52332--LT--59 ICD-10-CM: N20.1
⚠️ Verify with your specific payer’s NCCI policy before reporting stent separately. Many Medicare MACs bundle 52332 into 52352 when performed in the same session.
Example 4 - Inpatient with Urosepsis (Inpatient Coder Scenario)
A 70-year-old female admitted with high fever, rigors, and right flank pain. CT reveals a 1.2 cm obstructing stone at the right ureteropelvic junction (UPJ) with upstream hydronephrosis. Labs confirm SIRS criteria met; blood cultures grow E. coli. Sepsis is documented by the physician secondary to ureteral obstruction. Urologist performs ureteroscopy with stone extraction and stent placement on hospital day 2.
Principal Diagnosis: A41.51 (Sepsis due to E. coli) — sepsis is the reason for admission Secondary Diagnoses:
- N20.0 (Calculus of kidney — UPJ stone)
- N13.2 (Hydronephrosis with renal and ureteral calculous obstruction)
- N39.0 (UTI — underlying source)
ICD-10-PCS Procedures:
- 0TC37ZZ (Extirpation, right kidney pelvis, endoscopic)
- 0T177DZ (Bypass, right ureter, open/endoscopic — if stent coded as bypass) or 0T978DZ (Drainage, right ureter, endoscopic) — Root operation for stent placement is payer/Coding Clinic-dependent; query physician if unclear
Probable MS-DRG: Review with CDI — principal Dx of sepsis shifts case to MDC 18; DRG 871/872/873. The urologic OR procedure may affect secondary DRG logic. Ensure CC/MCC capture (N13.2 may qualify as CC depending on payer grouper version).
Example 5 - Multiple Stones, Same Ureter
Patient has two 5mm stones in the right ureter — one at the mid-ureter and one at the UVJ. Both are basketed and extracted during the same ureteroscopic session.
Multiple stones within the same ureter during a single ureteroscopic session = one unit of 52352. CPT codes for ureteroscopy are reported per ureter/session, not per stone.
Example 6 - Attempted Ureteroscopy, Converted to Stent Only
Urologist attempts ureteroscopy for left proximal ureteral stone. Scope cannot be advanced past a tight ureteral stricture. Procedure is converted to stent placement only.
CPT: 52332--LT (stent placed; ureteroscopy not successfully performed) CPT (if attempting 52352): Consider -52 (reduced services) with 52352 OR report only 52332 — document clearly what was and was not accomplished. ICD-10-CM: N20.1, N13.5 (stricture of ureter)
🔗 Related & Commonly Associated Codes
| Code | Description |
|---|---|
| 52351 | Diagnostic ureteroscopy (no therapeutic intervention) |
| 52353 | Ureteroscopy with lithotripsy |
| 52354 | Ureteroscopy with biopsy/fulguration |
| 52355 | Ureteroscopy with resection of ureteral/pelvic tumor |
| 52356 | Ureteroscopy with lithotripsy + stent |
| 52332 | Cystoscopy with insertion of indwelling ureteral stent |
| 50590 | Lithotripsy, extracorporeal shock wave (ESWL) |
| 50080 | Percutaneous nephrostolithotomy (PCNL), up to 2 cm |
| 50081 | PCNL, greater than 2 cm |
| 74420 | Retrograde ureterography |
| 74485 | Dilation of ureter |
📝 Clinical & Documentation Tips
- Always specify laterality in the operative report and in diagnosis coding (N20.1 does not have laterality; ICD-10-PCS codes require right vs. left designation).
- Document whether the calculus was removed (extracted) or manipulated (repositioned without removal) — both satisfy the code, but documentation must match.
- If fluoroscopy was used, it is generally bundled; document its use but do not bill separately without confirming payer allowance.
- Stone analysis results (oxalate, uric acid, struvite, etc.) support medical necessity and long-term metabolic management coding but do not change the surgical code.
- For inpatient encounters, ensure the CDI team is querying for CKD stage, sepsis, obstructive nephropathy, and diabetes — these dramatically impact DRG weight and reimbursement.
- Operative report must clearly state that a ureteroscope was passed — not just a cystoscope — to justify the 52352 over 52320 or 52330.
📚 References
Footnotes
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CMS Physician Fee Schedule - MPFS Look-Up Tool. cms.gov/medicare/physician-fee-schedule ↩ ↩2
-
CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services. cms.gov/medicare/coding-billing/national-correct-coding-initiative-edits ↩
-
AHA Coding Clinic for ICD-10-CM/PCS. American Hospital Association. ahacodingclinic.org ↩ ↩2
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CMS MS-DRG Definitions Manual & IPPS Final Rule. cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps ↩