Urology Coding Alert

Question: Can I bill for a cystolithotomy and suprapubic tube (SPT) placement together? I don’t see any bundling edits between codes 51050 and 51040, but is the SPT placement included in the work of the cystolithotomy procedure?

Georgia Subscriber

Answer: You are correct that the National Correct Coding Initiative (NCCI) edits do not bundle codes 51050 (Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection) and 51040 (Cystostomy, cystotomy with drainage) together. Therefore, you can report them together if the documentation supports both procedures.

Some urologists may consider the SPT placement an integral part of 51050, but you can technically report both. Often, after an open cystotomy, the urologist performs a primary closure of the bladder with Foley catheter urethral drainage and no suprapubic cystostomy tube. For some urologists, a suprapubic tube is optional in this procedure and therefore not always an integral part of a suprapubic operation. You can consider it a separate procedure and thus a chargeable service. Some payers may bundle codes 51040 and 51050 and only reimburse for the 51050, so be sure to check your individual payer’s policy.