Urology Coding Alert

Question: A patient was scheduled for an open sigmoid colectomy by the GI surgeon. A bladder injury and bilateral ureteral transection occurred during the case. Two left ureters and a right ureter were divided accidently during resection of the bladder where cancer had extended from the colon locally. Our urologist was called in during the surgery and repaired the bladder injury with reimplantation of the two left ureters and the right ureter. What procedure and diagnosis codes should we report?

Idaho Subscriber

Answer: Coding this case with certainty is difficult without seeing the full operative report, but the most likely coding scenario is:

• 50782 (Ureteroneocystostomy; anastomosis of duplicated ureter to bladder) with modifier LT (Left side) appended. Attach diagnosis codes N99.72 (Accidental puncture and laceration of a genito­urinary system organ or structure during other procedure), S37.13XA (Laceration of ureter, initial encounter), and Q62.5 (Duplication of ureter)
• 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) with modifiers RT (Right side) and XS (Separate structure) appended. Use diagnosis codes N99.72 and S37.13XA
• 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple) with modifier 51 (Multiple procedures) attached, if your payer requires the multiple procedure modifier. Assign diagnosis codes N99.72 and S37.23XA (Laceration of bladder, initial encounter).