Fragments travel from ureter to bladder

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Outpatient professional procedure; cited Medicare NCCI relationship

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Initial findings

Fictional adult has two documented stones in the left ureter. The initial bladder examination identifies no stone originating in the bladder. A left ureteroscopic lithotripsy procedure is performed during the same encounter; no right ureter is treated.

Treatment course

The two left ureteral stones are fragmented. Some fragments pass into the bladder during the procedure. The clinician removes that resulting debris before completing the endoscopic work. The report explicitly traces the bladder fragments to the treated ureteral stones.

Service counts

The operative note lists two ureteral calculi and several smaller fragments after treatment. It describes one left-sided ureteroscopic lithotripsy encounter. Neither stone count nor the later debris count establishes a new side or a new independent procedure.

Claim review

A draft includes two units for the ureteral procedure and another bladder-stone procedure for the resulting fragments. Review both the per-procedure unit and the origin-specific bladder rule. Exact final entry and any device combination require the full authorized book.

Your coding worksheet

Map the stones before and after treatment.
Review the two-unit proposal.
Determine whether a newly originating bladder stone is documented.
Explain both proposed additions.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The original calculi are in the left ureter; the bladder debris results from their fragmentation.
NCCI H.3 does not assign one unit per calculus for the described ureteroscopic procedure.
No independently originating bladder calculus is supplied.
NCCI C.29 excludes the proposed separate bladder-stone pathway for fragments resulting from treatment higher in the tract.

Reference sections: C.29,H.3

Practice the linked chart questions