Urology Coding Alert

Question: My surgeon performed an intraoperative renal ultrasound and true-cut biopsy on a Medicare patient. The frozen cells came back atypical, so he proceeded with cryoablation using the Endocare system. Again, the urologist did this under ultrasound guidance. How should I code this?

Massachusetts Subscriber Answer: No CPT code describes an open cryoablation of renal masses. Therefore, for a Medicare patient, use 50205 (Renal biopsy; by surgical exposure of kidney) for the open renal needle biopsy, 53899 (Unlisted procedure, urinary system) for the cryoablation, and 76940-26 (Ultrasound guidance for, and monitoring of, visceral tissue ablation; professional component) for the ultrasonic guidance. Append modifier -26 to indicate that the urologist did not perform the technical portion of 76940. The hospital or facility should bill 76940-TC (Technical component) for the technical portion.

Another way: Report the cryoablation with one of the codes from the 50220-50240 series (Nephrectomy). Under the code for a laparoscopic ablation, 50542 (Laparoscopy, surgical; ablation of renal mass lesion[s]), the CPT manual advises, "For open procedure, see 50220-50240."

Do this: Check with non-Medicare carriers to see if they will reimburse for HCPCS "S" codes. If they do, you could report S2090 (Ablation, open, one or more renal tumor[s]; cryosurgical) for the cryoablation procedure.