CPT code 52356: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy

What is Cystourethroscopy with ureteroscopy and/or pyeloscopy

CPT 52356 describes a procedure in which a surgeon performs a cystourethroscopy with ureteroscopy and/or pyeloscopy, often followed by laser lithotripsy to break up urinary stones and the placement of an indwelling ureteral stent. This ureter and pelvis transurethral intervention is typically used to treat stones in the right kidney, right ureter, or pelvis, and is considered one of the more advanced procedures for treating stones in the pelvis.

The procedure involves inserting a scope through the urethra to visualize and treat stones or obstructions, using lasers for fragmentation, and placing a stent to ensure ongoing treatment and drainage.

CPT 52356 represents a primary procedure that combines stent placement and stone removal on the same side and should not be reported with 52352 unless addressing separate stones in separate ureters or locations.

For appropriate treatment and proper coding, physicians must document the actual definition of services provided, such as when treating three separate stones or a separate lesion, to ensure compliance with CPT correct coding directives and protect patient treatment.

CPT code 52356 documentation requirements

To support accurate billing and compliance with CPT correct coding directives maintained by the American Medical Association, documentation for CPT 52356 must include:

• Clinical indication, such as a ureteral stone, hydronephrosis, or right kidney obstruction.
• Use of ureteroscopy and/or pyeloscopy as the approach under pelvis transurethral surgical procedures.
• Detailed description of the site and size of stone(s) in the ureter and pelvis transurethral region.
• Type of laser lithotripsy used (e.g., holmium laser) and dilation technique with device specification.
• Whether stone clearance was achieved and details of the indwelling ureteral stent or stent placement post-procedure.
• Use of fluoroscopy or other imaging, if performed.
• Clarification on whether multiple stones or separate stones in separate locations were treated, which impacts coding (e.g., whether also to report CPT 52352).

Physicians should also document if the procedure involved removing multiple stones, basketing a separate ureter, or treating three separate locations. This supports proper coding and appropriate treatment documentation as emphasized by the National Correct Coding Initiative and ensures alignment with coding clinic guidance to protect patient treatment.

Billing guidelines

• Do not report dilation or lithotripsy separately – CPT 52356 includes ureteroscopy, dilation, lithotripsy, and stent placement as a bundled procedure.
• Report once per ureter per session, regardless of the number of stones treated.
• Use modifier -RT or -LT to specify the right or left ureter. Use modifier -50 for bilateral procedures when the procedure is done on both ureters during the same session.
• CPT 52332 (indwelling ureteral stent placement) should not be reported separately—it is already included in 52356.
• Fluoroscopy (e.g., CPT 76000) can be reported separately if not bundled and if used for purposes beyond standard guidance, but check payer-specific rules.

Other relevant CPT codes

• 52353 – Cystourethroscopy with lithotripsy
• 52344 – Cystourethroscopy with dilation only
• 52352 – Stone manipulation without lithotripsy