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2 Codes Portray Lithotomy with Stent + Tube Placement

Published on Fri Jun 13, 2014

Question: We had a patient who was taken to the operating room today for left percutaneous nephrolithotomy performed after obtaining access via a nephrostomy tube placed the day prior to his procedure. The urologist fragmented the stone with the ultrasonic lithotripter and removed the stone fragments until no further stone fragments were visualized. He then placed an antegrade stent and replaced the nephrostomy tube at the completion of the procedure. Should I code with 50392, 50081, 50393 and 50394?

Codify Forum Member

Answer: You should report 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) or 50081 (... over 2 cm) depending on the size of the stone your urologist removed, which you don’t give in your question. 
 
Then, you will report 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous) for the nephrostomy tube placement. 
 
You should not report 50393 (Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous). Your urologist percutaneously inserted a stent antegrade through the kidney for drainage, and this antegrade placement of a stent is included in the procedure 50080 or 50081 and is not separately reportable or billable. 
 
Reporting 50394 (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter) is not appropriate unless your urologist performed a nephrostogram, which you do not mention in the above scenario. 

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