Urology Coding Alert

Question: The surgeon did a cystoscopy and retrograde pyelogram to aid in renal access, a percutaneous renal access and dilation,  a percutaneous lithotripsy, PCNL,  of a renal pelvic  stone >2cm,  and an antegrade ureteroscopy and removal of a distal ureteral stone. He then placed a nephrostomy tube and did an antegrade nephrostogram. How should I code this scenario?

New Jersey Subscriber

Answer: Apply the following codes to your clinical scenario:

• 50081 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm) for the PCNL with diagnosis N20.0 (Calculus of kidney); this includes the nephrostomy drainage at the end of the case
• 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous) for the renal access
• 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) for the cystoscopy and retrograde pyelogram
• 50961 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) with modifier XS (Separate structure) for the ureteroscopic ureteral stone removal with associated diagnosis N20.1 (Calculus of ureter)
• 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance [e.g., ultrasound and fluoroscopy] and all associated radiological supervision and interpretation; existing access) for the performance of the nephrostogram, including interpretation, via an existing access.

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