Urology Coding Alert

Question: My urologist did a very involved procedure for a patient with a ureteral tumor, bladder cancer and hydronephrosis. He performed a partial cystectomy, a ureterectomy, a ureteroneocystostomy and double-J stent placement.
 
I'm looking at CPT codes 51550 (Cystectomy, partial; simple), 50660 (Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal approach), 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) and 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent). Can I bill for all of these procedures using modifier -59?

Georgia Subscriber
 
Answer: The information available suggests that the urologist performed a partial cystectomy and excision of the lower ureter (partial ureterectomy) at the same time on the same side of the bladder. Partial cystectomy and ureteroneocystostomy are combined in one CPT code: 51565 (Cystectomy, partial, with reimplantation of ureter[s] into bladder [ureteroneocystostomy]). Start with that code, and add 50650 (Ureterectomy, with bladder cuff [separate procedure]), which is the nearest code to describe the excision of the lower ureteral segment.
 
Also report 50605 (Ureterotomy for insertion of indwelling stent, all types) for what was certainly an open insertion of a stent. There are no National Correct Coding Initiative edits affecting this combination of codes, so you won't need to append modifier -59 (Distinct procedural service) to break the bundles.
 
Often the bladder tumor on one side of the bladder obstructs the ipsilateral (same-side) ureter, ureteral orifice, and invades part of the lower ipsilateral ureter. The surgical procedure is usually removal of that part of the bladder, the ureteral orifice, and the lower ipsilateral ureter. The remaining ureter with its renal segment is then reimplanted into the bladder on that same side but into another new bladder location.

- 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, New York; and Morgan Hause, CCS,  CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.