Urology Coding Alert

Coding separately for stents can earn you an extra $300 for each pyelotomy

Assuming that stent insertion is included in most UPJ stricture treatments is a common coding mistake - and potentially a very costly one. Our experts explain how to get all the reimbursement you're entitled to for these complex procedures.
 
Scenario: When a child has a stricture in the ureteropelvic junction (UPJ) the kidney produces urine faster than it can drain out of the renal pelvis into the ureters causing hydronephrosis (a buildup of urine within the kidney) and a dilation of the renal pelvis. A few patients improve without surgery especially within the first 18 months of life. However if the urologist determines that surgery is necessary he has several options - each with its own coding idiosyncrasies.

Option 1: Acucise Endopyelotomy

For an Acucise endopyelotomy the urologist inserts an Acucise balloon catheter into the ureter under fluoroscopic guidance. The catheter can simultaneously dilate and incise the obstruction. Report this procedure with CPT Codes 52342 (Cystourethroscopy; with treatment of ureteropelvic junction stricture [e.g. balloon dilation laser electrocautery and incision]) says Dorothy Baker CPC coding and billing specialist for Pediatric Urology of North Carolina in Raleigh.
 
Key: When the urologist postoperatively places a double-J stent to help urine drain from the kidney report 52332 (Cystourethroscopy with insertion of indwelling ureteral stent [e.g. Gibbons or double-J type]) says Michael A. Ferragamo MD FACS clinical assistant professor of urology at the State University of New York Stony Brook. Be sure to append modifier -59 (Distinct procedural service) to break the National Correct Coding Initiative bundle with 52342 and show that it is a distinct procedure from the endopyelotomy.

Option 2: Laparoscopic Pyeloplasty

Immediately before a laparoscopic pyeloplasty procedure the urologist often performs a cystoscopy and retrograde pyelogram and places a J stent for drainage and to help identify the ureter. He then performs reconstructive surgery on the pelvis through a laparoscope.
 
Report 50544 (Laparoscopy surgical; pyeloplasty) for the laparoscopic pyeloplasty linked to ICD-9 Codes 753.21 (Congenital obstruction of ureteropelvic junction) says Rene Coker CPC account manager at Upstate Pediatric Urology in Greenville S.C. You can also report the stent placement with 52332. Because the two codes are not bundled you do not need to append modifier -59.
 
Link the stent insertion to 591 (Hydronephrosis). ""I also like to add V07.8 (Other specified prophylactic measure) as a secondary diagnosis indicating a prophylactic procedure "" Ferragamo says.
 
Watch for: NCCI bundles the cystoscopy and retrograde pyelogram into CPT 52332 code 50750 (Ureterocalycostomy anastomosis of ureter to renal calyx).

Under these circumstances you may also bill for other ancillary procedures the urologist performs such as an open nephrostomy (50040 Nephrostomy nephrotomy with drainage) or open stent insertion (50605 Ureterotomy for insertion of indwelling stent all types) Ferragamo says.