Urology Coding Alert

Question: During laparoscopic nephroureterectomy for renal pelvic tumor we start the case by cystoscopically placing a guidewire and using a resectoscope to excise the ureteral orifice with surrounding bladder cuff. What code would you suggest for the cystoscopic portion of the case?

Answer: The optimum curative surgery for a renal pelvic tumor includes total removal of the kidney and ureter including the ureteral orifice and a cuff of bladder surrounding the orifice. For the cystoscopic excision of the ureteral orifice and bladder cuff, use 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra or periurethral glands).

On the other hand, if a transurethral resection of the orifice and surrounding bladder is performed as a preliminary procedure before the laparoscopic total nephroureterectomy, code 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; small bladder tumor[s] [0.5 to 2.0 cm]). Even though a bladder tumor is not present, this code would best represent the resection of the orifice and surrounding bladder area.

You'll likely use 189.1 (Malignant neoplasm of renal pelvis) as your diagnosis code for this procedure.