Kidney stones are the calcifications (body’s excess minerals and salts) that can form inside your kidneys. These deposits usually consist of calcium oxalate but may be composed of several other compounds as well. As these substances begin to accumulate in the kidneys, they harden and form a crystal. As multiple crystals accumulate and join together in a more compact form, they end up with a pebble-like formation called a kidney stone. Also called renal lithiasis or nephrolithiasism, kidney stones have many causes and can develop anywhere along your urinary tract – in the kidneys, ureters, bladder or urethra. Kidney stones vary in size and shape. They can start as small (as a grain of sand) and grow as large (to the size of a golf ball) while maintaining a sharp, crystalline structure. Passing kidney stones can be extremely painful. However, these do not cause any permanent damage if they are identified in a timely manner. Treatment for this condition varies, depending on the type of stone and the specific causes. Most cases can be easily treated through pain medications and by consuming lots of water (to flush out a kidney stone through your urinary system). Nephrology medical billing and coding can be complex as it requires correct understanding of the rules related to the usage of codes and modifiers and payer specific guidelines. Partnering with a reliable medical billing and coding outsourcing company that has expert coders and billing specialists on board is the perfect strategy to report and bill for these services correctly.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), kidney stones are more common among males than females. Most people who develop this condition fall in the age group 30 – 50 years. Studies show that this condition affects one in eleven people in the United States. The causes of kidney stones vary according to the type of stones which include – cystine, stuvite, uric acid and calcium. Lack of water in the body is one of the leading causes of this condition. Medical conditions such as Crohn’s disease, urinary tract infections, renal tubular acidosis, hyperparathyroidism and Dent’s disease also increase the risk of kidney stones.
What Are the Major Symptoms?
Generally, a kidney stone remains symptomless until it moves around within your kidney or passes into your ureter (the tube connecting the kidney and bladder). Common symptoms include –
- Severe pain in the groin and/or side
- Vomiting and nausea
- Urinating more often than usual
- Pus in the urine
- Persistent need to urinate
- Burning sensation during urination
- Blood in urine
- Fever and chills (if there is an infection)
- Urinating in small amounts
Kidney stones that normally remain inside the body can also cause several complications including blockage of the tube connecting the kidney to the bladder (which obstructs the path that urine uses to leave the body).
Diagnosis and Treatment
Diagnosis of kidney stones involves a detailed health assessment and physical examination. Initial procedure involves blood and urine testing to identify the exact causes of stones. Blood tests may be carried out to identify the related complications that may accompany a kidney stone. These tests include – blood tests for calcium, phosphorus, uric acid, and electrolytes, blood urea nitrogen (BUN) and creatinine to assess kidney functions. On the other hand, urinalysis will check for crystals, bacteria, blood, and white cells in the urine and if there is subsequent infections. In addition, analysis of passed stones may also be done to determine the type of kidney stones.
As part of the diagnosis, urologists or other physicians may request diagnostic imaging tests such as abdominal X-rays, Intravenous pyelogram (IVP), retrograde pyelogram, Ultrasound of the kidney, MRI scan of the abdomen and kidneys and abdominal CT scan as these identify kidney stones in your urinary tract.
Treatment for kidney stones varies, depending on the type of stone and the cause. Generally, small kidney stones will not require any invasive form of treatment. These can be effectively managed by consuming more water (drinking six to eight glasses of water a day) as this increases urine flow. People who are dehydrated or have severe nausea and vomiting may need intravenous fluids. Medications like ibuprofen (Advil), acetaminophen (Tylenol), and naproxen sodium (Aleve) may help manage pain. Other medications – allopurinol (for uric acid stones), thiazide diuretics (for calcium stones) and sodium bicarbonate or sodium citrate help make the urine less acidic.
On the other hand, kidney stones that are too large to pass on their own because they cause bleeding, kidney damage or ongoing urinary tract infections may require more-extensive treatment which include – extracorporeal shock wave lithotripsy (ESWL), Tunnel surgery (percutaneous nephrolithotomy) and Ureteroscopy.
Medicare Coverage for Kidney Stones
Medicare Part B covers all medically necessary kidney stone treatment your physician recommends. This may include coverage for both traditional surgical/endoscopic techniques and modern lithotripsy techniques. Traditional approaches for the treatment of kidney stones are the surgical technique Nephrectomy (or nephrotomy) and endoscopic treatments via the urethra. In addition to the traditional approaches for the treatment of kidney stones, the following lithotripsy techniques like – Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Lithotripsy and Transurethral Ureteroscopic Lithotripsy are also covered.
Medical Codes to Use for Kidney Stones
Nephrology medical coding involves using the specific ICD-10 diagnosis codes and CPT procedure codes on providers’ reimbursement claims.
ICD-10 Codes to Indicate a Diagnosis of “Kidney Stones”
- N20 – Calculus of kidney and ureter
- N20.0 – Calculus of kidney
- N20.1 – Calculus of ureter
- N20.2 – Calculus of kidney with calculus of ureter
- N20.9 – Urinary calculus, unspecified
- N21 – Calculus of lower urinary tract
- N21.0 – Calculus in bladder
- N21.1 – Calculus in urethra
- N21.8 – Other lower urinary tract calculus
- N21.9 – Calculus of lower urinary tract, unspecified
- N22 – Calculus of urinary tract in diseases classified elsewhere
CPT Codes
- 52332 – Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)
- 52352 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
- 52353 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)
- 52356 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent
- 50080 – Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm
- 50081 – Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm
- 50395 – Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous
- 50430 – Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance
- 50431 – Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance
- 50432 – Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance
- 50433 – Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance
- 50561 – Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
- 52005 – Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service
- 52332 – Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)
- 74420 – Urography, retrograde, with or without KUB
- 52317 – Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)
- 52318 – Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)
Healthy lifestyle changes along with medications can help control the formation of stones inside the kidneys. Maintaining proper hydration is one of the top preventive measures. For people with a history of kidney stones, physicians usually recommend drinking enough water to pass about 2.6 quarts (2.5 liters) of urine a day. Increasing the amount of urine you pass helps flush the kidneys. Other preventive measures include – consuming a diet low in salt and animal protein, eating calcium-rich foods and eating fewer oxalate-rich foods. In addition, physicians may also prescribe medications to help prevent the formation of calcium and uric acid stones.
Medical billing and coding for kidney stones can be complex. By outsourcing medical coding tasks to a reliable medical billing and coding company (that offers the services of AAPC-certified coding specialists), healthcare practices can ensure correct and timely medical billing and claims submission.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.