Urology Coding Alert

Question: A patient was diagnosed with a kidney stone and multiple ureteral stones. The urologist performed PCNL to eliminate the kidney stone. I'm trying to find a code for the antegrade ureteroscopy with lithotripsy and stent. The chart notes are, "Left PCNL <2cm. Left antegrade ureteroscopy with laser lithotripsy and ureteral stent. Intro of guide into renal pelvis and ureter with dilation to establish nephrostomy tract, percutaneous, new access. Placement of nephrostomy catheter, percutaneous." What code(s) do you recommend?

Florida Subscriber

Answer: Begin with 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) for the PCNL. Add 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous), for the renal access, and code 50432 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance [e.g., ultrasound and/or fluoroscopy] and all associated radiological supervision and interpretation) for the nephrostomy catheter placement and radiographic studies and interpretations.

If the physician performed an antegrade ureteroscopy with laser lithotripsy through the existing nephrostomy, report 50961 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) and append modifier 59 (Distinct procedural service) or XS, (Separate structure) to undue an edit with procedure code 50432.