Urology Coding Alert

Question: Which code should I report for ureteroscopic endopyelotomy to treat a ureteropelvic junction stricture? The procedure was completed using ureteroscopy only. I am debating between 50575 and 52345. Both code descriptors sound like they could apply to this scenario.

Florida Subscriber

Answer: Because your urologist performed the complete procedure via ureteroscopy, you should report code 52345 (Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision)). CPT^® code 50575 (Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)) would not apply in this scenario based on the approach documented in the operative note.

“Because this scenario in this question states ureteroscopic endopyelotomy, you should report the 52345. However, if the documentation stated that the endoscopy was performed in an antegrade fashion through a nephrotomy or pyelotomy through the kidney into the ureter, then you would report code 50575,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland.

Don’t miss: During a 52345 procedure, the provider performs a cystourethroscopy, which is the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings. Your provider will use a cystoscope passed through the urethra and into the bladder. The urologist will also pass a ureteroscope up to the ureteropelvic junction (UPJ), where they will choose from various methods (balloon dilation, laser, electrocautery, and incision) to treat a UPJ stricture.