Ureteroscopy with Laser Lithotripsy (Ureteral / Renal Stone)

CPT 52353 · 7.31 wRVU · 0-day global

CPT52353

wRVU7.31

Global0-day

ApproachEndoscopic

ComplexityModerate

Add-on / Variant CPTs

52352 wRVU: 6.58 — Ureteroscopy with removal of calculus
52356 wRVU: 7.8 — Ureteroscopy with lithotripsy AND removal of fragments

Preoperative Diagnosis:

Right [left] [ureteral / renal] calculus, [X] mm at [proximal / mid / distal ureter / renal pelvis / lower pole], obstructive [/ symptomatic]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] ureteroscopy with holmium laser lithotripsy [and stone basket extraction]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Nurse/tech name]

Anesthesia:

General endotracheal [/ spinal / MAC]

Indications:

The patient is a [age]-year-old [male/female] with a [X]-mm right [left] [ureteral / renal] calculus at the [location] presenting with [renal colic / obstructive uropathy / UTI with obstruction]. Stone was not amenable to [observation / ESWL] given [size / location / infection / obstruction]. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The ureteroscope was advanced to the level of the stone without difficulty [/ with access sheath]. The stone was [X] mm, [tan / yellow / brown], [mobile / impacted in the ureteral wall]. Holmium laser lithotripsy reduced the stone to [fragments < 2 mm / dust]. The ureter was [normal / with mucosal edema / with perforation; none]. The kidney collecting system was [normal / with additional calyceal stones]. A [DJ stent] was placed for [ureteral edema / perforation / complete stone clearance not achieved].

Description of Procedure:

The patient was positioned in the dorsal lithotomy position. The genitalia were prepped and draped. A [9.5/11.5-Fr] ureteral access sheath [/ no access sheath] was placed over a [0.038-inch Sensor] guidewire under fluoroscopic guidance. The working guidewire was advanced to the [renal pelvis].

A [flexible / semi-rigid] ureteroscope was advanced alongside [/ through] the access sheath to the level of the stone. The stone was visualized at [X], [X] mm, [tan / yellow] in color.

A [200-micron] holmium laser fiber was introduced through the working channel. Laser settings: [0.5 J / 10 Hz / 5W, fragmentation] [/ 0.2 J / 40 Hz, dusting]. The stone was fragmented to [<2-mm dust]< pieces span>. [Stone fragments were retrieved with a [2.4-Fr NCircle / stone basket] and extracted.] Residual dust was irrigated out.

Fluoroscopy confirmed [no residual stone > 4 mm]. The ureter and collecting system were inspected: [normal mucosa / mucosal edema]. A [6 Fr × 26-cm] double-J ureteral stent was placed under fluoroscopic guidance with the proximal coil in the renal pelvis and distal coil in the bladder. Stent position was confirmed. The guidewires were removed.

Complications:

None

Specimens:

Stone fragments [if retrieved]: sent to stone analysis laboratory

Estimated Blood Loss:

Minimal

Drains:

[Double-J ureteral stent in place] / None

Disposition:

The patient was taken to the PACU in stable condition. Post-operative KUB [/ CT] was obtained to confirm stent position. The stent was to be removed in [2–4 weeks] in the office. Stone metabolic workup was recommended for [recurrent stone formers].

Epic SmartPhrase Version

PREOPERATIVE DIAGNOSIS: Right/Left *** calculus, *** mm at ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left ureteroscopy with holmium laser lithotripsy
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General/spinal/MAC

INDICATIONS: .PTAGE-year-old .PTSEX with *** mm *** stone at ***, obstructive/symptomatic. Consent obtained.

FINDINGS: Stone *** mm at ***, *** color, ***. Lithotripsy: fragmented to *** mm/dust. Ureter normal/***. DJ stent placed/not placed.

PROCEDURE:
Dorsal lithotomy. Genitalia prepped. [Access sheath *** Fr over Sensor wire.] Flexible/semirigid URS to stone level. *** mm stone visualized. Holmium laser *** J / *** Hz. Fragmented to ***. [Basket retrieval.] Fluoro: no residual >4 mm. Ureter inspected: ***. [DJ stent *** Fr × *** cm, proximal coil renal pelvis, distal coil bladder.] Position confirmed fluoro. Wires removed.

EBL: Minimal
SPECIMENS: Stone fragments to stone analysis
COMPLICATIONS: None
DISPOSITION: PACU. KUB stent confirmed. Stent removal *** weeks.

Signed: .ME, .MYDEGREE
.TODAY

Variants

Percutaneous Nephrolithotomy (PCNL): Large Renal Stone

For a [staghorn / >2 cm] renal calculus not amenable to URS or ESWL, PCNL was performed. Under fluoroscopic guidance [/ ultrasound guidance], a [18-gauge] needle was used to access the [lower / upper / middle] pole calyx in the prone position. An [Amplatz 30-Fr] sheath was dilated over the wire. A [nephroscope] was passed and the stone was fragmented with [ultrasonic / holmium laser] lithotripsy. Fragments were suctioned and extracted. A [20 Fr] nephrostomy tube [/ tubeless PCNL with DJ stent] was left for drainage. PCNL is the procedure of choice for stones >2 cm or staghorn calculi, offering superior stone-free rates compared to ESWL.

Charting Tips

Document whether a ureteral stent was placed and the reason. Post-ureteroscopy stent placement is not always required. Document the indication (ureteral edema, perforation, incomplete clearance, infection, solitary kidney) and the planned stent duration and removal method (string vs. cystoscopic).
Document stone size and appearance before and after lithotripsy. The pre-treatment stone size establishes the indication, while the post-lithotripsy assessment (residual fragments, completeness of clearance) determines whether additional intervention is needed.
Document laser settings used. Holmium laser parameters (energy, frequency, total power) affect fragmentation efficiency and ureteral thermal injury risk. Dusting settings (high frequency, low energy) are preferred for stones >10 mm to avoid fragment migration.

Billing Tips

52356 (ureteroscopy with lithotripsy + basket extraction, 7.80 wRVU) is the highest-weighted ureteroscopy code and covers the most common combined procedure: laser lithotripsy with fragment removal.
52353 (ureteroscopy with lithotripsy only, 7.31 wRVU) applies when stone is fragmented without extraction (dust-to-dust technique); 52352 (basket/forceps removal without lithotripsy, 6.58 wRVU) for intact stone extraction.
Do not stack 52352 + 52353. Use 52356 when both lithotripsy and extraction are performed at the same ureteroscopy session.
Ureteral stent placement at the conclusion of ureteroscopy: 52332 is bundled into ureteroscopy codes when performed at the same session. Do not bill separately.
Global period is 0 days (endoscopic). Subsequent stent removal visit (52310 or 52315) or stone check urogram is separately billable.
Document: stone location (renal vs proximal/mid/distal ureter), size, number of stones treated, access sheath use, laser settings, and stent placement. These details support the operative note and coding defensibility.
Bilateral ureteroscopy in one session: bill each side separately with -RT/-LT; bilateral rates apply. Document each side as a separate procedure with its own indication.

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