Urology Coding Alert

Don’t miss additional reportable procedures that bring in deserved reimbursement.

When your urologist documents that he performed a percutaneous nephrostolithotomy (PCNL), don’t stop there. If you automatically report 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) or 50081 (... over 2 cm) and send the claim, you could be costing your surgeon hundreds of dollars for each procedure. 

Read on to learn about several procedures that urologists may perform along with PCNL procedures, to ensure you aren’t missing out on billable services. 

Start with 50080 or 50081

As noted above, you will first report 50080 or 50081 for the actual PCNL surgery. Choose between the codes based on the size of the largest stone your urologist treats and removes, not on the stone burden, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. Both codes include dilation, internal lithotripsy, stenting, and basket removal, as the descriptors indicate.

Don’t miss: Depending on your payer, you may also be able to separately report 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous) for the percutaneous access to the surgical site. Additionally, if your urologist accesses more than one site, you might be able to report a second instance of 50395. You will need to attach modifier 59 (Distinct procedural service) or modifier 22 (Increased procedural service) to explain the additional reimbursement you’re requesting, Ferragamo says. 

“Do not bill this code if the renal access has been obtained for you by an interventional radiologist prior to your procedure,” Ferragamo warns. “The interventional radiologist will then most likely bill code 50395.”

Check for Imaging

Often, a urologist will perform a nephrostogram to help guide the PCNL procedure. If your urologist does so, report 50394 (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter) for that procedure. 

Caution: Be sure your urologist actually performed the nephrostogram before reporting 50394. This may not be a procedure a urologist performs with every PCNL. 

Money matters: If your urologist did a nephrostogram and you miss coding for it, this omission will cost your practice around $105.83: the product of multiplying 2.96 unadjusted relative value units (RVUs) by the 2015 quarter one national conversion factor rate of $35.7547. 

Pointer: If your urologist interprets (reads) the nephrostogram and documents his findings within the operative report, you may also bill 74425 (Urography, antegrade[(pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation). Attach modifier 26 (Professional component) to show he only performed the interpretation, not the technical portion.

Remember to Report the NP Tube Placement

Another commonly performed procedure with a PCNL is placement of a nephrostomy tube at the conclusion of the procedure. For that, you will report 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous).

“This should only be billed if the urologist did not perform the access to the kidney,” Ferragamo says. “50392 is bundled into code 50395, and these two codes should not be billed together during a PCNL.”

Pitfall: Most often your urologist will percutaneously insert a stent antegrade through the kidney for drainage, and this antegrade placement of a stent is included in the PCNL procedure codes (50080 or 50081) and is not separately reportable or billable. Therefore, you should not report 50393 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous).

Money matters: If your urologist did place a nephrostomy tube and you miss coding for it, this omission will cost your practice around $185.57: the product of multiplying 5.19 unadjusted relative value units (RVUs) by the 2015 quarter one national conversion factor rate of $35.7547.

Scope Out Renal Endoscopies

Finally, you may find that your urologist also performed renal endoscopy and incision of an infundibular stricture during the PCNL procedure. Report 50557 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy) to represent this procedure. 

Money matters: If your urologist did a renal endoscopy and incision of an infundibular stricture and you miss coding for it, you will cost your practice around $428.70: the product of multiplying 11.99 unadjusted relative value units (RVUs) by the 2015 quarter one national conversion factor rate of $35.7547.

Had you urologist performed a PCNL, a nephrostogram, an NP tube placement, and an incision of an intra-renal stricture, but you only reported 50080 or 50081, you would have forfeited over $720 in additional deserved reimbursement. 

Note: Other procedures you may bill for if your urologist performs them during a PCNL include: 

• 52005 — Cystourethroscopy, with ureteral catheterization with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service
• 52332 — Cystourethroscopy with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)
• 74420-26 — Urography, retrograde with or without KUB.