Urology Coding Alert

Hint: 51595 includes a pelvic lymphadenectomy.

In some cases, your urologist may perform a urinary diversion to make a new way for urine to leave the patient’s body. They will usually perform a urinary diversion when the normal flow of urine is blocked, or the bladder can no longer store urine. Most commonly, urologists will perform a urinary diversion after a patient’s whole bladder is removed due to bladder cancer.

Follow four handy tips to make sure you always submit clean urinary diversion claims in your practice.

Tip 1: Rely on These Options for Continent Diversion

When it comes to urinary diversions, your urologist may need to perform a continent diversion, which you can report with the following codes:

• 50825 (Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)). Note: A Koch pouch relates to a 70 cm segment of ileum being reformed into a peristaltic pouch with two nipple valves. Camey enterocystoplasty uses a 35-40 cm segment of intact ileum anastomosed to the urethral stump to create a continent intestinal reservoir. Ureters are sutured into a 3 to 4 cm trough in the bowel mucosa in each limb of the reservoir to create effective antireflux flap valves.
• 50810 (Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis). Note: In this procedure the intact anal-rectal muscular complex will maintain urinary continence, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Continent diversion defined: Continent diversion procedures include an abdominal or pelvic pouch, composed of the small and/or large bowel. They involve a continent stoma, which must be periodically catheterized to empty the pouch.

Example: Your urologist uses a small and/or large bowel to form a reservoir or pouch into which they reimplant the ureters. Your urologist constructs its opening to the outside so that it remains continent. This requires periodic catheterization to empty the pouch. Report code 50825 on your claim for a continent urinary diversion.

Tip 2: Report 50815 or 50820 for Conduit Procedures

On the other hand, if your urologist performs a conduit procedure, look to the following codes:

• 50815 (Ureterocolon conduit, including intestine anastomosis)
• 50820 (Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)).

Conduit: When it comes to conduits, there are two different types that your urologist may perform. The first type is an ileal conduit, which involves the small bowel. The second type, a colon conduit, involves the large bowel utilizing either the sigmoid colon or the transverse colon. All conduit procedures have incontinent stomas requiring the patient to continuously wear a drainage appliance.

Example: Your urologist performs a urinary diversion that uses the terminal ileum, small bowel, to form a conduit or passageway leading out of the body, usually into a urinary collection device. He performs this procedure to establish an outflow tract in which to place or reimplant the ureters. Report 50820 on your claim.

Don’t miss: If your urologist implants both ureters into the conduit procedure, append modifier 50 (Bilateral procedure) to codes 50815 and 50820.

Tip 3: Follow This Advice for Cystectomy With Diversion

Oftentimes, your urologist will perform a cystectomy along with a urinary diversion. In this case, you have specific codes to turn to. They are as follows:

• 51590 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis) and 51595 (... with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes)
• 51596 (Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder).

If your urologist performs a cystectomy along with a urinary diversionary procedure, the code choice depends on which urinary diversionary procedure your urologist performed, explains Melanie Scott, CPC, CPPM, CMPE, director of operations of Five Valleys Urology in Missoula, Montana. For a cystectomy with a ureteroileal conduit or sigmoid bladder, report 51590.

For a cystectomy, ureteroileal conduit, and also including a bilateral pelvic lymphadenectomy, report 51595, Ferragamo says.

If your urologist performs a cystectomy with continent diversion, report 51596, Scott says. If they perform a bilateral pelvic lymphadenectomy with that procedure, you can additionally report code 38770 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)) with modifier 50 appended for a bilateral pelvic lymphadenectomy.

Tip 4: Don’t Mix up “Undiversion” With “Diversion”

If your urologist performs an “undiversion” instead of a diversion, you will look to an entirely different code: 50830 (Urinary undiversion (eg, taking down of ureteroileal conduit, ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy)).

Undiversion defined: An undiversion is when the urologist takes down or removes a urinary diversion such as an ileal or sigmoid conduit and reimplants the ureters into the bladder or into each other. A urologist will perform an undiversion to reestablish the urinary tract following previous operations of ileal conduits, ureterosigmoidostomy, or ureteroenterostomy with ureteroureterostomy or ureteroneocystostomy.

Coding tip: If your urologist only takes down or removes an ileal or colonic conduit without ureteral implantations, append modifier 52 (Reduced services) to code 50830.

Before choosing the correct CPT^® code for your clinical scenario, check for key words in the dictation such as “continent” or “incontinent diversion/conduit, ileal or sigmoid pouch”, and “with or without pelvic lymphadenectomy,” Ferragamo adds.