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2025 CPT code 52318

Litholapaxy: crushing or fragmentation of calculus by any means in the bladder and removal of fragments; complicated or large (over 2.5 cm).

Follow current CPT guidelines for reporting surgical procedures.Accurate documentation is essential to ensure proper coding and reimbursement.

Modifiers may be applicable depending on the circumstances of the procedure (e.g., 59 for a distinct procedural service, 22 for increased procedural services). Consult the current CPT guidelines and local payer policies for appropriate modifier use.

Medical necessity for litholapaxy is established by the presence of symptomatic bladder calculi causing urinary obstruction, infection, or significant pain.The size of the stone (greater than 2.5 cm) justifies the use of this more complex procedure rather than simpler alternatives.

The urologist or surgeon is responsible for performing the procedure, including prepping the patient, inserting the cystourethroscope and lithotripter, crushing the stone, removing fragments, and confirming complete stone removal.

IMPORTANT:For stones smaller than 2.5 cm, use CPT code 52317.

In simple words: This medical code describes a procedure to remove a large bladder stone (bigger than 2.5 cm). A thin, tube-like instrument with a camera is inserted into the bladder through the urethra.A special tool then breaks the stone into smaller pieces, which are then flushed out.

This CPT code, 52318, represents litholapaxy—a procedure involving the crushing and removal of bladder stones larger than 2.5 cm.The procedure begins with the insertion of a cystourethroscope (a flexible or rigid tube with a camera) through the urethra into the bladder. The stone's location is identified, and a lithotripter (a device that crushes stones using shock waves) is introduced.The stone is then crushed, and fragments are removed via irrigation.The procedure is considered complicated due to the stone's size, potentially requiring extra time and potentially involving complications like fragments lodging in the urethra.

Example 1: A 65-year-old male presents with symptoms of urinary retention and hematuria. Imaging reveals a large bladder stone measuring 3 cm.The patient undergoes litholapaxy (CPT 52318) under general anesthesia. The stone is successfully crushed and removed., A 70-year-old female with a history of recurrent urinary tract infections presents with severe pain and dysuria.Cystoscopy reveals a 2.8 cm bladder stone.Litholapaxy (CPT 52318) is performed using an ultrasonic lithotripter, resulting in complete stone removal., A 50-year-old male with neurogenic bladder experiences worsening symptoms of urinary incontinence.A large bladder stone (3.5 cm) is detected during cystoscopy.The patient undergoes litholapaxy (CPT 52318), but due to the stone's hardness and size, multiple sessions are required for complete fragmentation and removal.

* Preoperative diagnosis and assessment, including imaging studies (e.g., X-ray, CT scan) demonstrating the presence and size of the bladder stone.* Operative report detailing the procedure, including the type of lithotripter used, the size and number of fragments removed, and any complications encountered.* Postoperative assessment and follow-up care.* Pathology report if stone analysis is performed.

** This procedure may be performed under various anesthesia types.The specific type of lithotripter used may also influence the procedural time and billing considerations.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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