Urology Coding Alert

When a patient's bladder has been removed and there is either a loop of intestine (ileal conduit) or an artificial bladder (intestinal continent pouch), the urologist is in a quandary when coding procedures that normally involve looking into the bladder, such as a cystourethroscopy (52000) and related procedures. If there is no bladder, do not use the cystourethroscopy codes. 
Scopes    
When performing an endoscopic procedure normally done in the bladder, you must consider the kind of artificial bladder you are looking into (pouch or conduit) as well as the procedure you are performing (biopsy, stone or stent removal).   
 
Conduit If you look in an ilieal loop, use 44380 (ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). If you perform a biopsy, use 44382 (... with biopsy, single or multiple).
 
Pouch If you look in a Kock or Indiana pouch, use 44385 (endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). With a biopsy, use 44386 (... with biopsy, single or multiple).
 
Stents If you remove a ureteral stent from a conduit or a pouch, append modifier -22 to the above codes. Use 44380-22 or 44385-22. 
 
To remove a stone endoscopically from a pouch, also use 44380-22 or 44385-22.