Summary & Overview
CPT 82355: Qualitative Analysis of Calculus Composition
CPT code 82355 denotes a qualitative laboratory analysis of a calculus (stone) to identify substances such as calcium, carbonate, cystine, magnesium, oxalate, phosphates, and urates. This diagnostic service helps characterize the composition of stones most commonly originating in the kidney and, less frequently, the gallbladder or other sites. Understanding stone composition guides clinical management, prevention strategies, and may influence downstream diagnostic or therapeutic decisions.
Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the test, typical service settings, and the role of 82355 in laboratory workflows. The publication also summarizes common payer considerations and benchmarking context where available. Data not available in the input will be noted where relevant.
This summary is intended for billing managers, laboratory directors, clinical coders, and policy analysts seeking concise context on the CPT code, how it is used in practice, and what to expect in payer coverage and reporting frameworks at the national level.
Billing Code Overview
CPT code 82355 describes a qualitative analysis of a calculus (stone) to identify constituent substances such as calcium, carbonate, cystine, magnesium, oxalate, phosphates, and urates. The test is performed by a laboratory analyst who examines a removed stone, which is most commonly of renal (kidney) origin but can also arise from the gallbladder or other anatomical sites.
Service type: Laboratory — stone (calculus) composition analysis; qualitative
Typical site of service: Clinical laboratory or hospital laboratory receiving surgically or spontaneously passed calculi; originating specimen often from the kidney but may be from the gallbladder or other locations.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to the urology clinic with acute flank pain and hematuria. Imaging (non-contrast CT of the abdomen/pelvis) identifies a renal calculus and the stone is removed via ureteroscopy and sent to the clinical laboratory for analysis. The laboratory receives a specimen labeled as “renal calculus” and the lab analyst performs a qualitative stone analysis to identify composition such as calcium oxalate, calcium phosphate, uric acid, cystine, struvite (magnesium ammonium phosphate), and carbonate. The typical workflow: specimen accessioning and verification, gross description and measurement, dissolution or sectioning as needed, qualitative chemical and microscopic testing, documentation of findings in the laboratory information system, and report generation to the ordering urologist. Typical site of service is an outpatient hospital laboratory, reference clinical laboratory, or hospital inpatient laboratory that supports surgical services. Service type: qualitative calculus (stone) analysis performed by a clinical laboratory professional to determine stone composition.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component of a service if applicable to lab services requiring separate professional interpretation. |
TC |