Urology Coding Alert

Question: How should I report a cystoscopy and change and replacement of right ureteral stent through an ileal conduit loop?

Massachusetts Subscriber

Answer: When your urologist is changing an externally accessible ureteral stent exiting from the ileal stomal ostium and using radiological control without any endoscopy of the loop, you should report 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) for unilateral or bilateral exchanges.

If your urologist uses imaging guidance, you should also report 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation).

Append modifier 26 (Professional component) to show that you are only coding for your physician's role in the monitoring.

If your urologist does an endoscopic exchange, use 44383 (Ileoscopy, through stoma; with transendoscopic stent placement [includes predilation]) for either unilateral or bilateral placement. In this case, you should also report 52310 (Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) for the stent removal from the loop. Append modifier 52 (Reduced services) since your urologist did not perform a cystoscopic examination. List 52310-52 as the primary procedure and 44383 as the secondary procedure based on the relative value units[RVUs].

Diagnosis help: The diagnoses you report will likely be 591 (Hydronephrosis) with 50688, 939.9 (Foreign body in genitourinary tract; unspecified site) with 52310, and 936 (Foreign body in intestine and colon) with 44383.

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.