Urology Coding Alert

Question: If the radiologist creates access for the urologist to perform laser lithotripsy and basket extraction of a stone, how should I code the urologist's service? Should I just bill 50561?

Maryland Subscriber

Answer: The confusion you and many other coders have when coding percutaneous nephrolithotomy (PCNL) comes from the previous bundling of the access code, 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous), into the initial PCNL codes 50080 (Percutaneous nephro-stolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50081 ( over 2 cm), which has since been unbundled. Therefore, billing for the percutaneous nephrolithotomy alone is entirely acceptable.

However, the code you are planning to use, 50561 (Renal endoscopy with removal of foreign body or calculus), is one of the two codes often used "secondarily" to the percutaneous nephrolithotomy codes the other being 50551 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service). In other words, 50561 may be used for removal of stone fragments left behind after lithotripsy (50080/50081). Often this occurs days after the initial procedure during a planned follow-up viewing of the interior of the renal pelvis and during the 90-day global period that corresponds to 50080/50081. In contrast, 50551 designates that the physician only checked to be sure there were no stones remaining after a PCNL and he confirmed that no stones were present.

For both of the secondary codes, you must have documentation in the first PCNL operative note that the urologist intended to perform 50561/50551. You should then append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to the secondary service code to show the payer you are aware of the 90-day global period that encompasses the initial service.