Urology Coding Alert

Question: A patient presented with previously placed nephrostomy tube and a 3-cm renal pelvic stone within the same kidney. The urologist preformed an antegrade pyelogram and after removing the nephrostomy tube used a Bard X-Force balloon to dilate the nephrostomy tract under fluoroscopy.

Then the physician prepared the nephroscope, removed the balloon and used the nephroscope. Using the Cyperwand lithotripter, he fragmented the stone using ultrasound and sucked out the fragments. Fluoroscopy revealed a small stone burden left, so the urologist used a cystoscope, a rigid nephroscope and grasping forceps to remove the fragments. He used a 22-french foley as a follow-up nephrostomy tube for postoperative drainage, and performed a second antegrade pyelogram to confirm tube position. He did not place a stent. Are 50394 and 50561 the only codes to use?

California Subscriber

Answer: No. You should report four codes for this procedure. First, for the fragmentation of the renal calculus and fragment removal, report 50081 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm).

Next, submit 50394 (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter) for the nephrostogram and antegrade pyelogram. Then, report 50398 (Change of nephrostomy or pyelostomy tube) for the changes of the nephrostomy tube.

Capture the urologist's reading of the nephrostogram and antegrade pyelogram using 74425 (Urography, antegrade [pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation). Append modifier 26 (Professional component) to indicate that your physician only read and interpreted the study.