OBJECTIVES

Cystoscopy-based stent removal (CBSR) is a common procedure following ureteroscopy with stent placement. Complicated stent removal CPT® code 52315 is designated for encrusted stents as defined by the AUA. No previous research has examined the stent removal usage pattern in a real-world practice. This study investigated factors associated with complicated stent removal among commercially insured patients in the US.

METHODS

We conducted a retrospective cohort study using IBM MarketScan Commercial database, a nationally representative data sample of the US population with employer-sponsored health insurance, to identify patients who had ureteroscopy with stent placement for stone disease between January 2014 and June 2018. Patients were included if they were ≥18 years old and had CBSR within 6 months post-index ureteroscopy. Patients were categorized as those with simple or complicated stent removal using CPT codes 52310 and 52315, respectively. Logistic regression was used to determine factors significantly influencing the occurrence of complicated stent removal. Factors we assessed included patient demographics and comorbidity, time to stent removal, stent removal site of service, and encrusted stent diagnoses.

RESULTS

Out of 16,682 patients undergoing ureteroscopy with stent placement, 465 (2.8%) had complicated CBSR. A majority of simple and complicated CBSR patients were males, aged 55-64 years, and located in South region. The mean days to stent removal for complicated CBSR patients were significantly higher than simple CBSR (16.5 vs 13.2; p=0.0004). Multivariate logistic regression found increased age, southern US geography, increased time to stent removal, and encrusted stent diagnoses were significantly associated with complicated CBSR. Patient comorbidities and stent removal site of service were not predictors of complicated CBSR.

CONCLUSIONS

Increasing patient age, geographic location, stent dwell time, and encrusted stent diagnoses are predictors of complicated stent removal billing in the US. Ureteral stents with anti-encrustation qualities may reduce the need for complicated CBSR.