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52353

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🩺 CPT 52353: Cystourethroscopy with Ureteroscopy/Pyeloscopy; with Lithotripsy

Last Updated: February 2026
Specialty Tags: urology endoscopy ureteroscopy stones lithotripsy medical_coding

CPT 52353 is used when cystourethroscopy is performed with ureteroscopy and/or pyeloscopy and lithotripsy is performed to fragment a calculus, and the descriptor notes that ureteral catheterization is included.

Quick reference table

ElementDetails
CPT code52353
Descriptor (clinical summary)Cystourethroscopy + ureteroscopy and/or pyeloscopy with lithotripsy (ureteral catheterization included).
Typical clinical useEndoscopic management of ureteral and/or renal pelvic stones using laser/pneumatic lithotripsy.
Global period000 global days
wRVU / RVU components~7.31 - non-facility; ~7.31 - facility
Medicare fee schedule (physician)343.70 - facility for the allowed amount.
Common POSASC (24), Outpatient hospital (22), sometimes inpatient (21).
Common anesthesiaTypically general anesthesia (clinical; payer policies vary).
LateralityDocument and bill the treated side when payer requires laterality (RT/LT).

📋Short definition

CPT 52353 reports cystourethroscopy with ureteroscopy and/or pyeloscopy, with lithotripsy performed to fragment a urinary tract calculus so fragments can be removed and/or pass.
The descriptor for 52353 indicates ureteral catheterization is included in the service.

Long definition (clinical + coding)

What is performed

The clinician performs cystourethroscopy (bladder/urethra endoscopy), advances to ureteroscopy and/or pyeloscopy (upper tract endoscopy), identifies a calculus, and uses lithotripsy to fragment the stone. In typical operative practice, fragmented stone material may be removed with a basket/forceps and/or allowed to pass, and irrigation is used for visualization and fragment management.

When lithotripsy is performed and an indwelling ureteral stent is inserted, many cases are instead reported with CPT 52356, which is described as ureteroscopy/pyeloscopy with lithotripsy including insertion of an indwelling ureteral stent.
Use 52353 when the case matches lithotripsy without the “including stent insertion” work that defines 52356.

Documentation requirements (audit-proof)

Pre-op (medical necessity)

  • Indication in plain language (e.g., symptomatic ureteral stone; obstructing stone; recurrent infection with stone; failed trial of passage; intolerable pain; AKI/obstruction risk).
  • Imaging summary (CT/US/KUB results) documenting stone size, location (kidney vs ureter; proximal/mid/distal), laterality, hydronephrosis if present.
  • Infection status: UA/urine culture, fever/chills, antibiotic plan; document if proceeding urgently vs staged due to infection risk.
  • Anticoag/antiplatelet status and periop plan.
  • Consent (bleeding, infection/sepsis, ureteral injury/perforation/stricture, need for stent, need for staged procedure, residual fragments, pain, anesthesia risks).

Intra-op (critical elements)

  • Laterality (Right vs Left vs Bilateral) and what side was actually treated.
  • Access: cystoscopy performed; ureteroscope advanced; whether ureteroscopy and/or pyeloscopy performed.
  • Stone details: location(s), estimated size, impacted vs non-impacted, number of stones.
  • Lithotripsy performed: modality (e.g., holmium laser), settings if your facility expects them, duration/extent, degree of fragmentation (“dusted” vs “fragmented and extracted”).
  • Adjuncts (if used): baskets, access sheath, ureteral dilation, retrograde pyelogram (note: imaging has separate radiology coding rules depending on who performs/reads).
  • Stent: placed or not; if placed, document stent type/size/length, laterality, and removal plan (office pull vs cysto removal date).

Post-op

  • Patient condition, complications (none vs specific).
  • Post-op meds and instructions (hydration, pain, hematuria expectations, return precautions).
  • Follow-up (stent removal date, imaging plan, metabolic stone workup).

Common ICD-10-CM diagnoses (choose most specific)

Stone diagnoses (most common)

  • N20.1 Calculus of ureter
  • N20.0 Calculus of kidney
  • N20.2 Calculus of kidney with calculus of ureter
  • N13.2 Hydronephrosis with renal and ureteral calculous obstruction (when documented)

Symptoms/complications (as supported)

Coding tip:

Pair the anatomic stone diagnosis (kidney vs ureter) with obstruction/infection codes only when documentation supports them.

Global period + Medicare “global surgery” rules (brief)

The Medicare global surgical package includes services normally furnished before, during, and after the procedure within the assigned global period, and the global indicator for each CPT code can be checked in the Medicare PFS Look-Up Tool. CMS explains that global surgery applies across settings (office, ASC, outpatient hospital, inpatient) and outlines 0‑day, 10‑day, and 90‑day global package concepts.
CMS also lists examples of services included in the global package (e.g., routine post-op visits, dressing changes, and removal of tubes/drains when part of normal recovery) and services excluded (e.g., diagnostic tests and procedures).

For this note: confirm the global days for 52353 in your year’s MPFS, then decide whether post-op E/M is bundled or separately billable.

Common modifiers (high-yield)

Always follow payer edits and your MAC guidance.

  • -RT / -LT: Laterality (when payer requires/accepts eye/side-style laterality reporting for ureter procedures).
  • -25 (E/M only): Significant, separately identifiable E/M on the same day as the procedure when documentation supports it.
  • -57 (E/M only): Decision for surgery for major procedures (only if the procedure’s global indicator is major and requirements are met).
  • -58: Staged/related procedure during a post-op period when planned or more extensive therapy is performed.
  • -78: Unplanned return to OR/procedure room for a related procedure during post-op period.
  • -79: Unrelated procedure during the post-op period (new global starts for the unrelated procedure).
  • -54 / -55 / -56: Split global package (surgical only / postop only / preop only) when a documented transfer of care occurs.

Fee schedule info (how to populate correctly)

Because RVUs, payment, and the global indicator are code- and year-specific, pull the following for CPT 52353 from the CMS Medicare PFS Look-Up Tool for your DOS and locality:

  • wRVU
  • PE RVU (facility vs non-facility)
  • MP RVU
  • Total RVU
  • Global indicator (000/010/090/YYY/XXX)
  • Allowed amount (facility vs non-facility)

If you want, tell me your Medicare locality/MAC (you’re in Raleigh, NC) and which year you’re targeting (2025 vs 2026), and I’ll format the exact MPFS values into the table in the style you’ve been using.

Compliance / audit red flags (quick)

  • Missing laterality (especially when documentation implies one side).
  • Op note doesn’t explicitly state lithotripsy occurred (must be clear to support 52353).
  • Stent insertion performed but coded as 52353 without clear rationale (review whether 52356 applies when stent insertion is part of the same session).
  • Diagnosis mismatch (e.g., stone procedure billed with only nonspecific symptom codes when imaging confirms calculus).

References (inline)

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