Urology Coding Alert

Question: One of our doctors completed a procedure that may qualify for code 50940. He was attempting to identify the left ureter because there was concern about potential entrapment. Documentation states that the posterior peritoneum was opened in order to visualize the left ureter. Once it was identified the urologist performed ureterolysis tracing the ureter distally to visualize the ureter lateral and posterior to the area of the most lateral cuff suture. There was no apparent injury to the ureter at that location so he turned the patient back over to the original surgeon. Although he recommended reporting 50940, he performed the procedure in an outpatient setting and 50940 is an inpatient-only code. Is there a better code to use?

Michigan Subscriber

Answer: If the ureterolysis was performed for surgical access rather than as a separate medically indicated procedure, it should not be reimbursed separately. Instead, you should code only the main procedure.

In the above scenario it seems that your physician freed the ureters from adhesions to avoid injury from the main procedure. The documentation you provide also seems to show that reporting 50940 (Deligation of ureter) is not appropriate for this encounter. Coding notes for 50940 explain that during this procedure the provider removes a constricting device, such as a suture, thread, wire, or constricting band inadvertently obstructing the ureter during surgery. That is not the service your urologist performed.

Take note: Ureterolysis (the freeing of the ureter in the retroperitoneal space) is bundled into many urological and general surgical codes. The changes generally follow CPT^® coding guidelines. For example, bundling ureterolysis code 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis) into most genitourinary procedures is in accordance with CPT^® guidelines that state lysing of adhesions, unless extensive, is included in the surgical approach.

Proper coding: Based on the above information and documentation, report 50600 (Ureterotomy with “exploration” or drainage (separate procedure)). Append modifier 52 (Reduced services) since the ureterotomy and drainage were not separately performed during the “exploration” of the ureter.