Summary & Overview
CPT 52318: Cystourethroscopy with Removal of Large Bladder Stone
CPT code 52318 represents a complex cystourethroscopy procedure to localize, crush, and remove a bladder stone larger than 2.5 cm. This endoscopic urologic intervention is clinically significant because large bladder calculi often require operative management under direct visualization and may affect resource use, site-of-service choice, and coding/billing determinations across payers. Nationally, the code is relevant to surgical practices, ambulatory surgery centers, hospitals, and payers assessing appropriate coverage for endoscopic stone removal.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication offers a concise overview of the clinical context for CPT code 52318, typical sites of service, and common billing considerations. Readers will find operational benchmarks and coding guidance context, summaries of payer policy trends where available, and clinical context that frames when this code is reported versus alternative approaches. The content is designed to support billing staff, coding professionals, and clinical administrators in understanding the procedure’s purpose, expected setting, and the payer landscape for large bladder stone removal.
Billing Code Overview
CPT code 52318 describes a complicated cystourethroscopy procedure in which a cystoscope is passed through the urethra into the bladder to inspect the interior of the bladder, the urethra, the prostatic urethra, and the ureteric openings, and to localize, crush, and remove a large bladder stone greater than 2.5 cm.
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Service type: Endoscopic urologic stone management involving visualization and mechanical fragmentation/removal of a large bladder calculus.
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Typical site of service: Ambulatory surgical center or hospital operating room where endoscopic urologic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents with recurrent gross hematuria, urinary urgency, and flank pain. Imaging (non-contrast CT) demonstrates a large intravesical bladder stone measuring 3.0 cm with suspected impaction near the ureteric orifice. The urology team schedules an operative cystourethroscopy for stone localization and removal. In the operating room under general or regional anesthesia, a rigid or flexible cystoscope is passed transurethrally to inspect the urethra, prostatic urethra, bladder mucosa, and ureteric orifices. The stone is localized, fragmented by lithotripsy (mechanical or energy-based), and removed with graspers or baskets. The procedure addresses a large stone greater than 2.5 cm and may include bladder irrigation, hemostasis, and placement of a Foley catheter postoperatively. Typical sites of service are the hospital operating room or an ambulatory surgery center. Preoperative documentation includes informed consent, imaging review, anticoagulation status, and relevant comorbidities. Postoperative documentation includes findings, stone size and fragments removed, complications or additional procedures performed, and postoperative disposition and instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, postoperative course | Use when the procedure is performed and recovery is uncomplicated. |
22 |