Urology Coding Alert

Question: I am wondering how best to code percutaneous nephrolithotripsy when interventional radiology (IR) performs the access to the kidney. IR is coding CPT 50393 and CPT 50392 done the day prior to the Urology surgery. Urology comes in the next day, accesses the kidney thru the established nephrostomy, dilates the tract, performs lithotripsy, and inserts a ureteral catheter. IR and urology are sort of sharing the work of code 50080-81 in separate operating sessions. Urology is also doing most of 50080-81, but is not creating the percutaneous passageway. There is also code 50561, but that does not describe lithotripsy. What is the correct way to report this surgery for my urologist's work?

Washington Subscriber

Answer: You should bill 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) or 50081 (... over 2 cm) based on the stone size for the percutaneous nephrostolithotomy.

Codes 50080 and 50081 both include the dilation of the tract, the lithotripsy, and the catheter insertion. You should not separately code 50561 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, installation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) with 50080 or 50081.

Don't miss: If your urologist also placed a nephrostomy tube for postoperative drainage, report  50392 (Introduction of intracatheter or catheter intorenal pelvis for drainage and/or injection, percutaneous) in addition to 50080 or 50081.