Urology Coding Alert

Question: Our doctor scoped a patient’s ileal vesicostomy with a flexible scope. He noted: “A spinal needle was advanced through the abdomen into the bladder. A Prolene stitch was advanced through the scope and pulled out through the abdomen wall. One end was tied to the Foley the other end was secured with a button at the anterior abdominal wall. The catheter was secured in place and confirmed by fluoroscopy.” Should we use 50688-52 or 44380-22 for this procedure?

Codify Forum Member

Answer: You should not report 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) or 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for this procedure, even with the addition of modifiers 52 (Reduced services) and 22 (Increased procedural services) as you suggest. 

Here’s why: Coder 50688 is incorrect as no ureterostomy or ureteral catheters were exchanged, and 44380 is incorrect as this code is used for an endoscopy of an ileal loop which was not part of the anatomy.

What to do: From the information you supplied, this patient had a bowl, most likely small bowl, attached to the skin and bladder as a passage way to the urinary bladder (ileal vesicostomy). Therefore, the urologist performed a cystoscopic examination via this conduit between the skin and bladder. For this procedure you should only report 52000 (Cystourethroscopy [separate procedure]) for the cystoscopic examination. 

Your urologist also placed a Foley catheter into the bladder via the vesicostomy, which was secured by a Prolene stitch passed percutaneously into the bladder and attached to the foley catheter and the abdominal wall. The placement of a catheter is bundled into the cystoscopic code and you should not separately bill for it.