Urology Coding Alert

Question: How should I report the ablation of a ureteral tumor when the urologist uses an open procedure?


Virginia Subscriber

Answer: As you've probably found, there is no code that exactly describes the open ablation of a ureteral tumor. In fact, there really isn't a code that even comes close. Therefore, use unlisted-procedure code 53899 (Unlisted procedure, urinary system) to report this procedure.

With your claim, send full documentation including a detailed operative report as well as a cover letter comparing this procedure with a similar surgical procedure (for example, 50600, Ureterotomy with exploration or drainage [separate procedure]; or 50610-50630, Ureterolithotomy...) to ensure reimbursement similar to what the insurer pays for the "comparable" or benchmark codes.