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Introduction:
The role of ureteroscopic laser lithotripsy (ULL) is well established for the management of ureteral stones and is increasingly accepted for renal stones. However, stone location is not currently differentiated by procedural name or billing code. We hypothesized that these cases are not equivalent in terms of the surgeon’s work as measured by the operating time, and we assessed if significant variations exist within the umbrella of CPT 52353: “ureteroscopic lithotripsy”.
Methods:
We retrospectively reviewed records of all patients undergoing unilateral ULL under the care of one fellowship trained endourologist between 2008 and 2010. Patients who underwent simultaneous additional endoscopic procedures, including bilateral ureteroscopy, were excluded. Demographics, operative time, stone size and location, and presence of previously placed stent were assessed and compared. Cohorts were designated according to stone location -- ureteral or renal.
Result:
Of the total 213 ULL cases reviewed, 115 were ureteral stones and 98 renal stones. Renal stones had a significantly increased mean operative time of 112 minutes versus 70 minutes for ureteral stones (p<0.001). Renal stone size was significantly larger (11.3mm vs 7.7mm, p<0.001), and these cases had a higher preoperative stent rate (55% vs 37%, p=0.0128).
Conclusions:
Despite bundling within a single CPT code, ureteroscopic management of renal stones and ureteral stones were markedly different, with a significant increase in operative time for renal stones. Renal stone size was significantly larger, as can be expected. In the same manner as resection of bladder tumors and lithotripsy of bladder stones, CPT differentiation should be considered.