Urology Coding Alert

Question: A report for a patient with kidney stones states that a stiff glidewire was advanced down a preexisting nephroureteral catheter, followed by the advancement of a balloon dilator into the area of the renal calculi. Following inflation, the surgeon placed a French access sheath into the collecting system, and a rigid nephroscope was subsequently inserted. The surgeon fragmented and evacuated the 1 cm renal stone using a CyberWand ultrasonic lithotripter. The lithotripter was reintroduced into the lower pole calyx for treatment of another cluster of small 3mm stones. The surgeon then inspected each calyx during a nephrostogram. Afterward, a French Council catheter was placed in the renal pelvis to serve as a nephrostomy tube. What’s the CPT^® coding?

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Answer: For the fragmentation and removal of the renal calculi, report code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm). This includes services performed for both the renal and lower pole calculi.

When coding for the nephrostogram, report code 50431 (Injection procedure for antegrade nephrostogram and/ or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access) since the provider used an existing access tract. As with the descriptor for 50431, this also includes reading and interpretation of the X-ray films produced. The dilation of the nephrostomy tract and the placement of a nephrostomy tube at the completion of the procedure are included in CPT^® code 50080 and not separately billable.