Urology Coding Alert

Question: The surgeon performed a left percutaneous nephrosto­lithotomy, an antegrade left ureteral stent placement, and left nephrostomy tube placement. I was considering using codes 50080, 50693, and 50432 but CCI edits say I need to include a modifier. The procedure involved only one stone. Can I use all three codes, and do I need a modifier?

Louisiana Subscriber

Answer: Begin with code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) with modifier LT (Left side) appended.

If your surgeon did not perform the renal access (50395, Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous) you may then bill for the nephrostomy tube placement at the conclusion of the procedure with 50432 (Placement of 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) and modifier LT. The antegrade placement of the ureteral stent is included in the work of code 50080 and not separately billable.

Modifier 51 (Multiple procedures) is not needed for Medicare patients but would be suggested for non-Medicare carriers to insure payment of the latter code. Since ICD-10's inception, many insurers (including Humana) are requiring left and right location indicators (modifiers LT or RT) even when the procedure only involves one side of bilateral organs.