Anesthesia Coding Alert

Question: What code should I submit for nephrostomy tube placement with CT guidance?

Answer: Several surgical -- and anesthesia -- coding options apply to nephrostomy tube placement, depending on the physician's technique. Verify how the physician performed the procedure to point you in the right direction.

Assess options: If the physician used an open technique, the surgical code is 50040 (Nephrostomy, nephrotomy with drainage) and crosses to anesthesia code 00862 (Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy).

Code 52334 (Cystourethroscopy with insertion of ureteral guidewire through kidney to establish a percutaneous nephrostomy, retrograde) represents the cystoscopy approach and crosses to 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified).

A third surgical option is 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous); it crosses to 00860 (Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; not otherwise specified).

Base-unit balance: You should always report the best code for accuracy's sake, and this is especially true when base-unit choices vary. Code 00910 carries three base value units, 00860 carries six, and 00862 carries seven. Knowing the surgical technique will help you report the best anesthesia code and get your physician the most appropriate reimbursement.

Last resort: When you're unsure of the best option, some coders recommend submitting a list of code descriptors to the physician and asking him to help choose the most appropriate one.

-- Answers to You Be the Coder and Reader Questions were provided by Emma LeGrand, CPC, CCS, coding supervisor for New Jersey Anesthesia/Health Network Management in Florham Park; Scott Groudine, MD, an Albany, N.Y., anesthesiologist; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.