Urology Coding Alert

Question: The physician performed an endoscopic examination of a patient’s ileovesicostomy using a flexible cystourethroscope. During the procedure, a catheter was placed in the ileovesi­costomy to help with urine flow. One end of the catheter was stitched to the bladder, while the other end of the catheter was fastened with a button on the front of the abdominal wall. The catheter’s position was secured. For this procedure, should we use 50688 with modifier 52 or 44380 with modifier 22?

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Answer: Neither 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) with modifier 52 (Reduced services) nor 44380 (Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) with modifier 22 (Increased procedural services) seem to accurately represent the procedure described.

Here’s why: Code 50688 is incorrect as there was no ureterostomy tube or externally accessible ureteral stent via ileal conduit exchanged. CPT^® code 44380 is also incorrect as this code is used to view the ileum by way of endoscopy of the digestive system.

From the information supplied, this patient had an ileovesicostomy, a type of urinary diversion, where a portion of the small intestine (ileum) was removed and used to create a new tube or channel from the top of the bladder to the outside of the skin on the abdomen, known as a stoma. Therefore, the urologist performed a cystourethroscopic examination via this conduit between the skin and bladder.

“CPT^® code 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) would be the appropriate coding choice because in the operative notice, a catheter was implanted in this patient,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland. Per the guidelines, “Because cutaneous urinary diversions utilizing ileum or colon serve as a functional replacement of a native bladder, endoscopy of such bowel segments, as well as performance of secondary procedures can be captured by using the cystourethroscopy codes,” says Storck.