Summary & Overview

CPT 52325: Cystourethroscopy with Ureteral Lithotripsy

Headline: CPT code 52325: Cystourethroscopy with Ureteral Catheterization and Ureteral Lithotripsy

Lead: CPT code 52325 identifies an endoscopic urologic procedure combining cystourethroscopy with ureteral catheter insertion and fragmentation/removal of a ureteral stone using methods such as ultrasonic or electrohydraulic lithotripsy. The code captures both the diagnostic inspection of the lower urinary tract and the therapeutic management of ureteral calculi.

CPT code 52325 is important nationally because it documents a common, resource-intensive urologic intervention used to relieve obstructing ureteral stones and prevent renal injury and infection. Typical settings include hospital operating rooms and ambulatory surgery centers where an operating urologist performs cystoscopy, ureteral catheterization, and lithotripsy with stone extraction. Key payers for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find clinical and billing context for CPT code 52325, including the scope of the procedure, expected site-of-service, and the kinds of operational and coding considerations that affect claims for endoscopic ureteral stone management. The publication provides benchmarks and policy-oriented discussion relevant to coverage, coding accuracy, and resource utilization for this urologic service. Data not available in the input: specific modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare52325CPTurologycystourethroscopyureteral lithotripsyendoscopystone removalambulatory surgeryoperating room

Billing Code Overview

CPT code 52325 describes a cystourethroscopy with ureteral catheterization and ureteral lithotripsy with fragmentation and removal of a ureteral stone using techniques such as ultrasonic or electrohydraulic lithotripsy. The procedure involves inspection of the interior of the bladder, urethra, prostatic urethra, and ureteric orifices via a cystoscope passed through the urethra into the bladder, followed by insertion of a catheter into the ureter to fragment and extract a ureteral calculus.

Service type: Endoscopic urologic procedure involving diagnostic cystoscopy and therapeutic ureteral stone fragmentation/removal
Typical site of service: Hospital operating room or ambulatory surgery center, performed by a urologist

Clinical & Coding Specifications

Clinical Context

A 48-year-old male presents to the urology clinic with acute right-sided flank pain, hematuria, and nausea. Urinalysis demonstrates microscopic hematuria and CT abdomen/pelvis without contrast confirms a 6-mm obstructing ureteral stone at the distal right ureter with mild hydroureteronephrosis. After failed conservative management including oral analgesics and medical expulsive therapy, the urologist schedules a cystourethroscopy with ureteral catheterization and intracorporeal lithotripsy.

In the operating room under general anesthesia, the patient is placed in the dorsal lithotomy position. A rigid or flexible cystoscope is introduced via the urethra to inspect the urethra, prostatic urethra, and bladder. The ureteral orifice is identified on the right; a guidewire and ureteral catheter are advanced into the ureter. A ureteroscope is passed into the ureter, the stone is localized, fragmented using ultrasonic or electrohydraulic lithotripsy, and fragments are removed with baskets or graspers. A ureteral stent may be placed at the end of the case for drainage. Typical postoperative workflow includes recovery, pain management, discharge with stent removal follow-up if placed, and documentation of operative findings and specimens if applicable.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s professional portion separate from technical facility resources (rare for this endoscopic procedure when billed by facility separately).
`50`	Bilateral procedure	Use if bilateral ureteral stones are treated in same session and payer allows bilateral modifier for endoscopic procedures.
`51`	Multiple procedures	Use when additional distinct procedures (separate CPT codes) are performed during the same operative session in addition to `52325`.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or complications.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedural service not normally reported together with other services.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Unplanned return to OR by same physician following initial procedure for a related procedure during the postoperative period	Use when the patient returns to the OR for a related procedure during the global period.
`79`	Data not available in the input.	Data not available in the input.
`52`	Data not available in the input.	Data not available in the input.

Taxonomy Code	Specialty	Notes
2084P0800X	Urology	Primary specialty performing cystourethroscopy and ureteroscopic lithotripsy.
207L00000X	Obstetrics and Gynecology	May perform cystoscopy in female pelvic surgery contexts, less common for ureteral lithotripsy.
207RH0000X	General Surgery	Urologic cases occasionally performed by surgeons with endourology training in some settings.
363L00000X	Nephrology	Typically not the proceduralist but involved in pre/post renal function management.
3336M0800X	Emergency Medicine	May perform initial cystoscopy in emergent settings; definitive lithotripsy performed by urology.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N20.1`	Calculus of ureter	Primary indication for ureteral lithotripsy to fragment and remove ureteral stones.
`N20.0`	Calculus of kidney	Renal calculi may migrate into the ureter and require ureteroscopic treatment; relevant when stone origin is renal.
`N13.2`	Hydronephrosis with ureteral stricture	Obstruction from stone can cause hydronephrosis; stricture may be identified and treated during endoscopy.
`R31.0`	Gross hematuria	Common presenting symptom prompting diagnostic cystoscopy and evaluation for ureteral source.
`N23`	Unspecified renal colic	Symptom code for acute colicky flank pain leading to procedural intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52332`	Cystourethroscopy, with ureteroscopy, with lithotripsy, with removal of fragments, with or without ureteral catheterization	A closely related ureteroscopic lithotripsy code; may be used when ureteroscopy (rather than cystoscope-directed ureteral instrumentation) is the primary technique.
`52310`	Cystourethroscopy, with injection procedure for reflux or for other therapeutic purposes	May be performed in same session if additional bladder therapy is indicated.
`52000`	Cystourethroscopy, diagnostic (separate procedure)	Used for diagnostic cystoscopy without instrumentation of the ureter; may be billed when only diagnostic inspection is performed.
`52320`	Cystourethroscopy with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography	Represents ureteral catheter placement alone; often performed as part of access for lithotripsy.
`52005`	Cystourethroscopy, with ureteral catheterization, with or without contrast, radiologic evaluation	Performed when imaging of the collecting system is performed during the procedure.