CPT 00918: Anesthesia for Ureteral Stone Fragmentation/Removal
CPT code 00918 designates anesthesia services provided during endoscopic procedures to fragment, manipulate, or remove ureteral calculi. This code is used when the surgical team accesses the ureter via the urethra to break and/or extract stones, and it captures the anesthetic component of those urologic interventions. Nationally, accurate use of this code supports appropriate billing for anesthesia in common urologic stone procedures and influences anesthesiology service reporting and resource allocation.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of the clinical context for 00918, how it relates to anesthesia service lines for endoscopic ureteral stone management, and its placement among related anesthesia codes for genital and perineal procedures. The publication outlines common billing considerations, typical sites of service, and the clinical scenarios that prompt use of this code. It also situates 00918 alongside neighboring anesthesia codes to clarify coding choices for urologic endoscopic stone procedures.
The content is intended for billing professionals, anesthesiologists, and health policy analysts seeking clear, nationally applicable information on the purpose and clinical setting for CPT code 00918.
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Billing Code Overview
CPT code 00918 describes anesthesia services for fragmentation, manipulation, and/or removal of a ureteral calculus. The service covers anesthesia provided while the surgical provider accesses the ureter through the urethra to break, manipulate, and possibly extract ureteral stones.
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Service type: Anesthesia for urologic endoscopic stone management
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Typical site of service: Operating room or ambulatory surgical center for endoscopic ureteral stone procedures
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the urology clinic with acute right flank pain, hematuria, and radiographic evidence of a 6 mm distal ureteral stone causing hydronephrosis. Conservative measures and medical expulsive therapy fail and the urologist schedules ureteroscopic stone fragmentation and extraction under general anesthesia. Preoperative evaluation documents a history of controlled hypertension (ASA P2) and no prior anesthesia complications. On the day of surgery the patient is admitted to an ambulatory surgery unit; anesthesia personnel perform pre-induction evaluation, induce general anesthesia with endotracheal intubation, provide intraoperative monitoring and analgesia, and manage emergence and immediate postoperative care. The urologist accesses the ureter via the urethra, fragments the calculus with a laser lithotripsy device, retrieves fragments with a basket, and places a ureteral stent. The anesthetic service is reported with 00918 for anesthesia for fragmentation, manipulation, and/or removal of a ureteral calculus via transurethral ureteroscopy. Typical site of service is the ambulatory surgery center or hospital operating room. Common perioperative workflow steps include preoperative evaluation, induction of general anesthesia or monitored anesthesia care as indicated, intraoperative anesthetic and hemodynamic management, postoperative recovery in PACU, and handoff to urology for discharge instructions or inpatient admission if complications occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure usually done with local or regional anesthesia and documentation supports medical necessity. |
50 | Bilateral procedure | Use if bilateral ureteral procedures are performed in the same anesthetic (rare for single-side stone). |
52 | Reduced services | Use when the anesthetic service is partially reduced or abbreviated and documentation supports reduction. |
53 | Discontinued procedure | Use when the procedure is terminated before completion for documented medical reasons. |
62 | Two surgeons | Use when two surgeons are required and both perform distinct portions of the procedure impacting anesthesia planning. |
78 | Unplanned return to OR | Use when a related procedure is needed during the global period requiring additional anesthesia care. |
79 | Unrelated procedure or service by same physician during postoperative period | Use when a separate, unrelated anesthetic service is provided in the postoperative period. |
AA | Anesthesia services performed personally by anesthesiologist | Use when the anesthesiologist personally performs the anesthesia. |
AD | Medical supervision by physician; more than four concurrent anesthetized patients | Use when supervising more than four concurrent cases and billing for medical supervision. |
QK | Medical direction of two, three, or four CRNAs by an anesthesiologist | Use when the anesthesiologist medically directs multiple CRNAs for this case. |
QS | Monitored anesthesia care (MAC) service | Use when the service provided is MAC rather than general endotracheal anesthesia. |
QX | CRNA service with CRNA billing under their own NPI (modifier for billing when applicable) | Use when a CRNA performs the anesthetic and billing rules require this modifier. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when the anesthesiologist directs one CRNA for the case. |
XE | Separate encounter | Use when billing for a separate anesthesia encounter distinct from the primary surgical episode. |
GC | Service performed in part by resident under teaching physician supervision | Use when a resident performs parts of the anesthetic under teaching physician oversight. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists providing general or regional anesthesia for urologic procedures. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who administer anesthesia in hospital or ambulatory settings for ureteroscopy. |
207LA0401X | Pain Medicine (Anesthesiology) | Anesthesiologists with pain subspecialty who may manage complex perioperative analgesia for patients with chronic genitourinary pain. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N50.9 | Disorder of male genital organs, unspecified | May co-occur when male genital inflammation or pathology is present during evaluation for ureteral stone or when coding broader genital complaints. |
N76.89 | Other specified inflammation of vagina and vulva | Included in the input set; relevant only if female pelvic inflammatory findings or vulvovaginal inflammation are present alongside urologic symptoms. |
N47.1 | Phimosis | Relevant when genital conditions affect urologic access or perioperative management in male patients. |
N48.1 | Balanitis | May impact perioperative assessment and infection control in male patients undergoing urethral instrumentation. |
N49.9 | Inflammatory disorder of male genital organ, unspecified | Broad code for male genital inflammation that could be listed as a comorbid condition during ureteroscopic stone management. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00910 | Anesthesia for procedures on male genitalia | Used when the anesthetic is for primary procedures on the male genitalia rather than ureteral stone work; select when the primary surgical site is male genitalia. |
00920 | Anesthesia for procedures on the perineum, perianal area | Relevant if the surgical approach or concurrent procedures involve the perineum or perianal region. |
00921 | Anesthesia for procedures on the perineum, perianal area, with rectal involvement | Use when rectal involvement is present in the operative field and affects anesthetic management. |
00924 | Anesthesia for procedures on the perineum, perianal area, with urethral involvement | Closely related when urethral instrumentation is a central component; choose based on primary operative site and documentation. |