Urology Coding Alert

Question: A patient presented with previously placed nephrostomy tube and a 3-cm renal pelvic stone within the same kidney. The urologist preformed an antegrade pyelogram and after removing the nephrostomy tube used a Bard X-Force balloon to dilate the nephrostomy tract under fluoroscopy.

Then the physician prepared the nephroscope, removed the balloon, and used the nephroscope. Using the Cyperwand lithotripter, he fragmented the stone using ultrasound and sucked out the fragments. Fluoroscopy revealed a small stone burden left, so the urologist used a cystoscope, a rigid nephroscope, and grasping forceps to remove the fragments. He used a 22-french foley catheter as a follow-up nephrostomy tube for postoperative drainage, and performed a second antegrade pyelogram to confirm tube position. He did not place a stent. Are 50394 and 50081 the only codes to use?

Florida Subscriber

Answer: CPT^® code 50394 was deleted in 2016. However, code 50081 is correct, but does not convey the entire story. First, for dilating the tract, fragmentation of the renal calculus, and fragment removal, report 50081 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm).

Next, code 50435 (Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance [e.g., ultrasound and/or fluoroscopy] and all associated radiological supervision and interpretation) represents the replacement of the nephrostomy catheter, performance of the nephrostogram, and the reading (interpretation) of the films. All these services are included in code 50435.