Urology Coding Alert

Question: What is the correct way to bill for ablation of renal tumors? Can I bill for each tumor that is documented?

Vermont Subscriber

Answer: CPT^® includes several code options for renal tumor ablation:

• 50250 – Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed 
• 50592 – Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency 
• 50593 – Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy.

You would submit the claim based on the ablation method the urologist uses. Because the descriptors represent either single or multiple tumors, you should only report each code once, no matter how many tumors the surgeon removes from the kidney. You can, however, append modifier 50 (Bilateral procedure) if the urologist removes tumors from both kidneys during the same operative session.

Important: Neither 50592 nor 50593 include image guidance and monitoring. If the urologist uses (and documents) image guidance and monitoring, you can report it separately with the appropriate code, depending on the type of guidance used:

• 77013 – Computed tomography guidance for, and monitoring of, parenchymal tissue ablation
• 77022 – Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation 
• 76940 – Ultrasound guidance for, and monitoring of, parenchymal tissue ablation.  

Do not bill for ultrasonic guidance for 50250 as per its definition 50250 includes intraoperative ultrasound guidance and monitoring if performed.