Urology Coding Alert

Remember to append modifier 50 where necessary to avoid a denial.

There are instances where a urologist might carry out a urinary diversion to establish a new route for urine to exit the patient’s body. This procedure is typically done when there’s an obstruction in the normal urine flow or when the bladder is incapable of retaining urine. It’s most frequently conducted following the total removal of a patient’s bladder due to bladder cancer.

Test your knowledge by reviewing these four frequently asked questions to make sure you always submit clean urinary diversion claims in your urology office.

Question 1: What are the specific codes that can be reported when a urologist performs a continent diversion as part of urinary diversions?

• 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 to 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: The urinary continence will be preserved by the intact anal-rectal muscular complex in this procedure.

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.

Question 2: When should you report 50815 or 50820 for conduit procedures?

You may struggle with the difference between these codes when your urologist performs a conduit procedure:

• 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. They perform 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.

Question 3: How should I code for cystectomy with diversion?

It’s common for a urologist to carry out a cystectomy in conjunction 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. For a cystectomy with a ureteroileal conduit or sigmoid bladder, report 51590.

Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime coder and consultant in Glen Burnie, Maryland, states, “It’s important to make sure the urologist documents all of the procedures and components performed to support the reporting of the appropriate diversion procedure to continue to flow of urine whether through a ileostomy, colostomy, or direct catheterization.”

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