Radiology Coding Alert

Question: Which CPT codes should I report for the following services performed at a single encounter for right and left nephrostomy tube placement?

" 21-gauge needle inserted into left renal pelvis under fluoro

" contrast injections to confirm needle position

" guidewire advanced into left renal pelvis

" nephrostomy catheter placed in pigtail position in left renal pelvis

" urine removed through nephrostomy catheter

" contrast injection to check catheter function

" above services repeated for right renal pelvis

" RS&I for both procedures.

Wyoming Subscriber

Answer: Code 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous) covers all of the services you describe except for the radiological supervision and interpretation (RS&I).

You should report the bilateral 50392 service according to your payers preference, such as appending modifier 50 (Bilateral procedure) to a single line item of 50392 or reporting 50392, 50392-50. The Medicare Physician Fee Schedule lists 50392 with a bilateral indicator of 1. This means 150 percent payment adjustment for bilateral procedures applies. If you report it twice on the same day by any method, Medicare will pay the lower of the total actual charge for both or 150 percent of the fee schedule amount for one code.

RS&I: For the RS&I, you should report 74475(Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous,radiological supervision and interpretation). Report it once for the right and once for the left.

Note that the contrast injections arent the same as a diagnostic antegrade pyelogram, so you should not report 74425 (Urography, antegrade [pyelostogram,nephrostogram, loopogram], radiological supervision and interpretation) and 50390 (Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous). To code an actual diagnostic antegrade pyelogram, the radiologist would need to document a full interpretation of the diagnostic study, and the decision to insert the nephrostomy tube would need to be based on that studys results. If the patient is simply referred for a nephrostomy, which often happens, then you should code only the nephrostomy.