Urology Coding Alert

Question: A urologist and a general surgeon together repair a colovesical fistula without bowel or bladder resection. The urologist also performs a left ureterolysis for an obstructed ureter due to retroperi-toneal fibrosis secondary to a long-standing retroperi-toneal abscess. The urologist also performs a cystoscopic examination and places a J-J stent. How should I code this for the urologist and his part of the surgery?

Montana Subscriber

Answer: Now this is a tricky one! Because the urologist acted as a co-surgeon and performed and dictated the bladder surgery, you should use 44660-62 (Closure of enterovesical fistula; without intestinal or bladder resection; two surgeons) for the urologist's service. The general surgeon should also use 44660-62 for his portion of the surgery on the bowel.

As for the ureterolysis, you will need to use modifier -59 (Distinct procedural service) to break the bundle of 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis) and 44660. Thus by coding the ureterolysis 50715-59, this procedure will be considered a distinct procedure above and beyond the fistula repair and with a different diagnosis. Appropriate ICD-9 diagnoses include 596.1 (Intestinovesical fistula), 567.2 (Retroperitoneal/abdominal abscess) and 593.4 (Retroperitoneal fibrosis).

And finally, for the double-J stent placement, 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]), use 52332-51 (Multiple procedures). For the urologist's part in the procedure, use 44660-62, 50715-59 and 52332-51.

Answers to You Be the Coder and Reader Questions contributed by Wendy Dicus, CPC, coding supervisor for Alaska Billing Services Inc. in Anchorage, Alaska; Connie Copeland, coder and HIPAA compliance officer for Urology Professional Association in Tupelo, Miss.; Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a physician practice management consulting firm in Spring Lake, N.J.; and Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.