Radiology Coding Alert

Question: Which CPT code(s) should I report for a single percutaneous approach to the kidney for two separate tubes, a percutaneous nephrostomy tube and completely internal ureteral stent?Kentucky SubscriberAnswer: Unless your payer tells you otherwise in writing, you may report both 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous) and 50393 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous).Reason: The procedures are separate services in different anatomic sites, although the radiologist uses a single percutaneous approach, according to the AMA's October 2005 CPT Assistant.Report the nephrostomy (renal pelvis) access with 50392 and the indwelling ureteral stent (such as a double-J stent) placement with 50393. Depending on your payer, you may need to append modifier 59 (Distinct procedural services) to 50393.Don't forget: You may report the appropriate radiological guidance codes for the procedures as well, such as 74475 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation) for 50392 and 74480 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation) for 50393.Watch out: When the physician inserts an internal-external ureteral stent (one end protruding outside the body and one end down in the ureter), the patient doesn't have a separate nephrostomy tube, so you would report only the ureteral stent codes.