Ureteroscopy with Laser Lithotripsy (Ureteral / Renal Stone)

CPT 52353
Approach Endoscopic
Add-on / Variant CPTs
  • 52352 — Ureteroscopy with removal of calculus
  • 52356 — Ureteroscopy with lithotripsy AND removal of fragments
Preoperative Diagnosis:

Right [left] [ureteral / renal] calculus — [X] mm at [proximal / mid / distal ureter / renal pelvis / lower pole], obstructive [/ symptomatic]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] ureteroscopy with holmium laser lithotripsy [and stone basket extraction]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Nurse/tech name]

Anesthesia:

General endotracheal [/ spinal / MAC]

Indications:

The patient is a [age]-year-old [male/female] with a [X]-mm right [left] [ureteral / renal] calculus at the [location] presenting with [renal colic / obstructive uropathy / UTI with obstruction]. Stone was not amenable to [observation / ESWL] given [size / location / infection / obstruction]. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The ureteroscope was advanced to the level of the stone without difficulty [/ with access sheath]. The stone was [X] mm, [tan / yellow / brown], [mobile / impacted in the ureteral wall]. Holmium laser lithotripsy reduced the stone to [fragments < 2 mm / dust]. The ureter was [normal / with mucosal edema / with perforation — none]. The kidney collecting system was [normal / with additional calyceal stones]. A [DJ stent] was placed for [ureteral edema / perforation / complete stone clearance not achieved].

Description of Procedure:

The patient was positioned in the dorsal lithotomy position. The genitalia were prepped and draped. A [9.5/11.5-Fr] ureteral access sheath [/ no access sheath] was placed over a [0.038-inch Sensor] guidewire under fluoroscopic guidance. The working guidewire was advanced to the [renal pelvis].

A [flexible / semi-rigid] ureteroscope was advanced alongside [/ through] the access sheath to the level of the stone. The stone was visualized at [X] — [X] mm, [tan / yellow] in color.

A [200-micron] holmium laser fiber was introduced through the working channel. Laser settings: [0.5 J / 10 Hz / 5W — fragmentation] [/ 0.2 J / 40 Hz — dusting]. The stone was fragmented to [<2-mm pieces / dust]. [Stone fragments were retrieved with a [2.4-Fr NCircle / stone basket] and extracted.] Residual dust was irrigated out.

Fluoroscopy confirmed [no residual stone > 4 mm]. The ureter and collecting system were inspected — [normal mucosa / mucosal edema]. A [6 Fr × 26-cm] double-J ureteral stent was placed under fluoroscopic guidance with the proximal coil in the renal pelvis and distal coil in the bladder. Stent position was confirmed. The guidewires were removed.

Complications:

None

Specimens:

Stone fragments [if retrieved] — sent to stone analysis laboratory

Estimated Blood Loss:

Minimal

Drains:

[Double-J ureteral stent in place] / None

Disposition:

The patient was taken to the PACU in stable condition. Post-operative KUB [/ CT] was obtained to confirm stent position. The stent was to be removed in [2–4 weeks] in the office. Stone metabolic workup was recommended for [recurrent stone formers].

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left *** calculus — *** mm at ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left ureteroscopy with holmium laser lithotripsy
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General/spinal/MAC

INDICATIONS: .PTAGE-year-old .PTSEX with *** mm *** stone at ***, obstructive/symptomatic. Consent obtained.

FINDINGS: Stone *** mm at ***, *** color, ***. Lithotripsy: fragmented to *** mm/dust. Ureter normal/***. DJ stent placed/not placed.

PROCEDURE:
Dorsal lithotomy. Genitalia prepped. [Access sheath *** Fr over Sensor wire.] Flexible/semirigid URS to stone level. *** mm stone visualized. Holmium laser *** J / *** Hz. Fragmented to ***. [Basket retrieval.] Fluoro: no residual >4 mm. Ureter inspected — ***. [DJ stent *** Fr × *** cm, proximal coil renal pelvis, distal coil bladder.] Position confirmed fluoro. Wires removed.

EBL: Minimal
SPECIMENS: Stone fragments to stone analysis
COMPLICATIONS: None
DISPOSITION: PACU. KUB stent confirmed. Stent removal *** weeks.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Percutaneous Nephrolithotomy (PCNL) — Large Renal Stone

For a [staghorn / >2 cm] renal calculus not amenable to URS or ESWL, PCNL was performed. Under fluoroscopic guidance [/ ultrasound guidance], a [18-gauge] needle was used to access the [lower / upper / middle] pole calyx in the prone position. An [Amplatz 30-Fr] sheath was dilated over the wire. A [nephroscope] was passed and the stone was fragmented with [ultrasonic / holmium laser] lithotripsy. Fragments were suctioned and extracted. A [20 Fr] nephrostomy tube [/ tubeless PCNL with DJ stent] was left for drainage. PCNL is the procedure of choice for stones >2 cm or staghorn calculi, offering superior stone-free rates compared to ESWL.

Charting Tips
  • Document whether a ureteral stent was placed and the reason. Post-ureteroscopy stent placement is not always required. Document the indication (ureteral edema, perforation, incomplete clearance, infection, solitary kidney) and the planned stent duration and removal method (string vs. cystoscopic).
  • Document stone size and appearance before and after lithotripsy. The pre-treatment stone size establishes the indication, while the post-lithotripsy assessment (residual fragments, completeness of clearance) determines whether additional intervention is needed.
  • Document laser settings used. Holmium laser parameters (energy, frequency, total power) affect fragmentation efficiency and ureteral thermal injury risk. Dusting settings (high frequency, low energy) are preferred for stones >10 mm to avoid fragment migration.
Billing Tips
  • 52356 (ureteroscopy with lithotripsy + basket extraction, 7.80 wRVU) is the highest-weighted ureteroscopy code and covers the most common combined procedure: laser lithotripsy with fragment removal.
  • 52353 (ureteroscopy with lithotripsy only, 7.31 wRVU) applies when stone is fragmented without extraction (dust-to-dust technique); 52352 (basket/forceps removal without lithotripsy, 6.58 wRVU) for intact stone extraction.
  • Do not stack 52352 + 52353. Use 52356 when both lithotripsy and extraction are performed at the same ureteroscopy session.
  • Ureteral stent placement at the conclusion of ureteroscopy: 52332 is bundled into ureteroscopy codes when performed at the same session. Do not bill separately.
  • Global period is 0 days (endoscopic). Subsequent stent removal visit (52310 or 52315) or stone check urogram is separately billable.
  • Document: stone location (renal vs proximal/mid/distal ureter), size, number of stones treated, access sheath use, laser settings, and stent placement. These details support the operative note and coding defensibility.
  • Bilateral ureteroscopy in one session: bill each side separately with -RT/-LT; bilateral rates apply. Document each side as a separate procedure with its own indication.