Urology Coding Alert

Question: I’m coding for many procedures during the same operative session: cystoscopy with left retrograde pyelogram, left ureteral catheter placement, left percutaneous access, left percutaneous nephrostolithotomy, nephrostomy tube placement, and ureteral catheter placement. How do I report all of this?

Texas Subscriber

Answer: For 2019 you should be able to report several codes for the encounter if the physician’s documentation clearly supports the procedures performed. Assuming that is true, here’s a rundown of the correct codes for each procedure:

• Cystoscopy with left retrograde pyelogram: CPT^® code 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) and 74420 (Reading of the retrograde pyelogram, Urography, retrograde, with or without KUB) with modifier 26 (Professional component)
• Left ureteral catheter placement: CPT^® code 52005
• Left percutaneous access: a new CPT^® code for 2019 suggested by the AUA in their “Policy and Advocacy Brief” for renal access, 50432 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation) with modifier 52 (Reduced services)
• Left percutaneous nephrostolithotomy: CPT^® code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) or 50081 (… over 2 cm). The choice of code will depend on the largest stone fragmented, not the stone burden or cumulative stone size.
• Final nephrostomy tube placement is now for 2019 also included in CPT^® codes 50080 or 50081 and should not be separately coded or billed.