Urology Coding Alert

Coding for open, laparoscopic or percutaneous drainage of the flank requires a distinction between methods of access, as well as location of the abscess or lymphocele that needs to be drained. There are no specific codes for different kinds of flank drainage procedures, so choosing an appropriate code is challenging.
 
Codes differ for renal and peritoneal abscesses and lymphoceles. There are distinctions between the kinds of drainage: percutaneous which requires radiological guidance as denoted by specific codes and open. Laparoscopic drainage can be done for lymphoceles. Bundling issues must be considered when coding for drainage of two areas.
 
Initial diagnostic tests require specific coding as well. Before the drainage, the urologist will perform an abdominal or renal ultrasound (76770, 76775 or 76778) or a computerized axial tomography (CAT) or computed tomography (CT) scan (74150). 
 
The codes in this newsletter are effective on Jan. 1, 2002.
Renal Drainage
Open drainage: If the patient has a complicated (multiloculated or multiple) perirenal or renal abscess or abscesses, the urologist will probably choose an open method of drainage, says Michael A. Ferragamo, MD, professor of urology at the State University of New York, Stony Brook. Use 50020 (drainage of perirenal or renal abscess; open) for open drainage.
 
Percutaneous drainage: If the abscess is small, single and easily accessible not near major blood vessels the urologist performs a percutaneous drainage and uses 50021 ( percutaneous).
 
Use 75989 (radiological guidance for percutaneous drainage of abscess, or specimen collection [i.e., fluoroscopy, ultrasound, or computed axial tomography], with placement of indwelling catheter, radiological supervision and interpretation) for radiological guidance for 50021. Add modifier -26 (professional component) if the procedure is done in the hospital to indicate that the urologist performed the interpretation but does not own the machine.
 
There is no code for laparoscopic drainage of any abscess, renal or peritoneal. Laparoscopies are used for drainage of noninfected material as the material drains into the peritoneal cavity. Laparascopic drainage is fine for a lymphocele but not for an abscess.

Peritoneal Drainage
Laparoscopic drainage: The laparoscopic code for peritoneal drainage for a lymphocele, which can occur after renal transplantation or retroperitoneal surgery, is 49323 (laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity). There is no code for laparoscopic drainage of a peritoneal abscess because such a procedure would not be performed.
 
Open drainage: Use 49062 (drainage of extraperitoneal lymphocele to peritoneal cavity, open) for open drainage of a lymphocele and 49060 (drainage of retroperitoneal abscess; open) for open drainage of a retroperitoneal abscess. Use 49020 (drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open) for open drainage of a peritoneal abscess.
 
Percutaneous drainage: Use 49061 (drainage of retroperitoneal abscess; percutaneous) for percutaneous drainage of a retroperitoneal abscess and 49021(drainage [...]