Urology Coding Alert

Question: How should we bill for a renal endoscopy, a nephrostomy, and a dilation of the ureter and ureteropelvic junction (UPJ) with stent insertion, all for UPJ obstruction? The doctor says he did parts of 50570-50575. The radiologist inserted the nephrostomy tube the day before. Our doctor inserted an endopyelotomy stent.

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Answer: Use 50575 (renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy [includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent]).
 
The CPT description for this procedure includes many different components. Because an endopyelotomy was not performed (cutting the obstruction at the UPJ) but only dilation, append modifier -52 (reduced services) to 50575. Placement of the endopyelotomy stent is included and is not separately billable. When appending modifier -52, send the operative report as well as a short note describing the procedure.
 
Do not code 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) or 52342 (cystourethroscopy; with treatment of ureteropelvic junction stricture [e.g., balloon dilation, laser, electrocautery, and incision]), as this was a renal endoscopy procedure. Also, dont code 50570 (renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service), because it doesnt include an endopyelotomy stent insertion.