Urology Coding Alert

See how well you would fare in a true situation.

Now that you’ve read about how to report percutaneous nephrostolithotomy (PCNL) surgeries and any accompanying procedures, try your hand at coding this sample case.

Scenario: The surgeon performed a left percutaneous nephrostolithotomy for a renal pelvic stone less than 2 cm in size, an antegrade left ureteral stent placement, and left nephrostomy tube placement. I was considering using codes 50080, 50693, and 50432 but Correct Coding Initiative (CCI) edits say I need to include a modifier. The procedure involved only one stone. Do I use all three codes, and do I need a modifier?

Answer: Begin with code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) with modifier LT (Left side) appended. If your surgeon did not perform the renal access do not report it using 50432-52 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; Reduced services). The placement of the nephrostomy tube is included in 50080. The antegrade placement of the ureteral stent is also included in the work of code 50080 and not separately billable.

Modifier 51 (Multiple procedures) is not needed for Medicare patients but would be suggested for non-Medicare payers to ensure payment for the secondary procedures, if performed.

Tip: Since ICD-10’s inception, many insurers are requiring left and right location indicators (modifiers LT or RT, Right side) even when the procedure only involves one side of bilateral organs.

In the above example, code 50080 alone would be the correct code for the clinical scenario.