Radiology Coding Alert

Question: What CPT and ICD-9 codes should I report for CT-guided renal cyst aspiration with contrast injection via an existing drainage catheter and cyst cavity alcohol sclerotherapy? This was an acquired cyst.

California Subscriber

Answer: The diagnosis code for an acquired cyst is 593.2 (Cyst of kidney, acquired).

For renal cyst aspiration, you should report 50390 (Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous). A note with 50390 instructs you to look to the following codes for radiological supervision and guidance:

• 74425 -- Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation

• 74470 -- Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation

• 76942 -- Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

• 77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)

• 77012 -- Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation

• 77021 -- Magnetic resonance guidance for needle placement (e.g., for biopsy, needle aspiration, injection, or placement of localization device), radiological supervision and interpretation.

Your physician documented that he used CT guidance, so you should report 77012.

Because you also indicated cyst cavity sclerotherapy, use 53899 (Unlisted procedure, urinary system). As always with an unlisted-procedure code, provide adequate documentation to tell the insurer what the doctor did, why you should get paid, and what fair reimbursement would be.

If your documentation shows fluoroscopic guidance for the sclerotherapy, you may need to override a Correct Coding Initiative edit to report the guidance (such as 77002).