Urology Coding Alert

Question My physician performed a ureteroneocystostomy with bladder cuff excision as well as left-sided pelvic lymphadenectomy. He also placed a cystostomy tube and ureteral stent. This was all performed as an open procedure for a malignant neoplasm of the ureter. I’m looking at 50780 for the ureteroneocystostomy and 38770 for the pelvic lymphadenectomy. I believe the bladder cuff is bundled, but I’m lost as far as the tube and stent placement. Is 51040 or 51045 correct?

Wisconsin Subscriber

Answer: Code 51040 (Cystostomy, cystotomy with drainage) is the correct choice for this scenario. You would not report 51045 (Cystotomy, with insertion of ureteral catheter or stent [separate procedure]) because this procedure is bundled into 51040 and cannot be unbundled.

You are also correct to report 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) for the ureteroneocystostomy and 38770 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]) for the pelvic lyphadenectomy. 

Payers bundle the excision of a cuff of bladder (50650, Ureterectomy, with bladder cuff [separate procedure]) and the stent placement in 50780. Thus, you cannot separately bill for those procedures.