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Urology Coding Alert

Reader Question:

50 vs. RT/LT for Bilateral Nephrostomy Replacement Depends on Payer

Published on Mon Feb 13, 2012

Question: A patient had bilateral nephrostomy tubes replaced. We were going to report CPT 50398 . Are we able to charge for the replacement twice? If so, would be bill it on one line or two and which modifiers would I need to add? Pennsylvania Subscriber Answer: For Medicare and some private payers you should report 50398 (Change of nephrostomy or pyelostomy tube). Don't miss: You should attach modifier 50 (Bilateral procedure). You should expect to receive the 150 percent payment adjustment for these bilateral procedures. Place a "1"in the unit column box 24G of the 1500 form. Some commercial and most private payers require two line billing with 50398-LT (Left side) on one line and 50398-50-RT (Right side) on the second line. Best bet: Check with the individual payer as to its coding preference for this clinical scenario.
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