Urology Coding Alert

Question: General surgeons or gynecologists often ask the urologists I code for to insert unilateral or bilateral ureteral catheters under the same anesthesia as the primary operation so the surgeon can identify the ureters and diagnose any inadvertent ureteral injury intraoperatively.

The urologist usually inserts the open ended ureteral catheters and leaves them to exit the urethra either attached to their own drainage system or that of the urethral catheter.

I have never been able to code for these procedures unless there is pre-op documentation of hydrone-phrosis/obstruction or some degree of renal insufficiency with an elevated creatinine. Is there a way to code this procedure when these diagnoses aren't present?

Hawaii Subscriber

Answer: When your urologist places ureteral catheters for ureteral identification during abdominal or pelvic surgery, payment for the cystourethroscopy and retrograde catheter insertion (52005, Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) will depend on the medical necessity or reason for the ureteral catheter placements. In turn, this will depend on the diagnostic codes.

When you choose a diagnosis code, first consider whether abnormal urological anatomy exists secondary to the pelvic or abdominal pathology. If present, report 591 (Hydronephrosis), 593.3 (Stricture or kinking of ureter), 593.5 (Hydroureter) or 593.89 (Other specified disorders of kidney and ureter; other), which includes "periureteritis."

Alternative: If no urinary abnormality or obstruction exists, then code the diagnoses for which the surgeon is performing his surgical procedure. A few examples might be diverticulosis/diverticulitis with or without hemorrhage (562.10-562.13), malignant tumor of sigmoid (153.3), malignant tumor of the rectosigmoid (154.0), malignant tumor cervix uteri (180.9), malignant tumor corpus uteri (182.0) or intramural leiomyoma of uterus (218.1).

Remember: Some insurers will not reimburse a urological procedure (52005) with non-urological diagnoses as indicated above. In addition, there may not be any urological abnormalities or diagnoses that you can report based on the physician's documentation. In this clinical circumstance, report the primary diagnosis for the ureteral catheters as 591, and for your secondary diagnosis use V07.8 (Other specified prophylactic measure). Using these diagnoses as primary and secondary, you're telling the carrier that the urologist is performing the procedure (52005) prophylactically to prevent the problem of possible hydronephrosis.

-- 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.