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Urology Coding Alert

Reader question:

Multiple Procedures Lead to Complex Coding

Published on Fri May 07, 2004

Question: One of my physicians performed an  percutaneous nephrostolithotomy with removal of stone and a Holmium laser and Bugbee ablation of caliceal diverticulum with dilation of the infundibulum. She also sewed a Councill catheter into place in the calyceal diverticulum, and placed a flexible nephroscope through the mouth of the diverticulum into the renal pelvis to inspect the kidney. She also performed a flexible ureteroscopy down the ureter and stopped at the ureteropelvic junction; however, she was able to pass contrast  into the bladder without obstruction. I'm starting with 50080, but I'm not sure where to go after that.

Indiana Subscriber

Answer: You are on the right track. Start with CPT code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm). Next, report the following codes:

  •  50557 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy) for the fulguration and the incisional opening of the calyceal diverticulum (this also includes the injection of contrast for the ureterogram at the bladder level).

  •  50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous) for the placement of the Councill catheter for drainage via the calyceal nephrotomy.

  •  74480-26 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation; Professional component) for reading of the x-ray if a specific and separate reading is added to the operative note.

    The endoscopy of the renal pelvis and ureter are inherent and included in both the 50080 and 50557 codes, so you should not consider them separate and significantly identifiable services for billing purposes.

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