Urology Coding Alert

Question: My urologist performed the following procedures in one session:

• left ureteroscopy through an ileal conduit

• ureteral brush biopsy

• cystoscopic JJ stent change

• cystoscopic retrograde pyelogram

• nephrostomy tube removal.

I know the pyelogram is part of the ureteroscopy code, but I'm not sure exactly what else I can report. What codes are best in this scenario?

Ohio Subscriber

Answer: You should first report 50955 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service; with biopsy) for the ureteroscopy and biopsy via an ileal conduit. Then, for the looposcopy and insertion of ureteral stents, use 44383 (Ileoscopy, through stoma; with transendoscopic stent placement [include predilation]).

Append modifier 51 (Multiple procedures) to 44383 to indicate that the urologist performed more than one procedure during the operative session.

Don't forget: The descriptor of 50955 includes performance of the retrograde pyelogram, but if the urologist interpreted the retrograde pyelogram and documented his readings in the medical records, you should also report 74420 (Urography, retrograde, with or without KUB). Append modifier 26 (Professional component) to show that the physician only interpreted the retrograde pyelogram.

Remember: There is no specific CPT code for the removal of a nephrostomy tube, so you will not submit a code for that service.