Urology Coding Alert

Question: My urologist performed a percutaneous stone removal, with the access being carried out by the radiology department. However, my doctor did not conduct a lithotripsy. Is lithotripsy a requirement for code 50080? According to the definition in the CPT^® code book, code 50080 covers “percutaneous nephrostolithotomy with or without dilation, endoscopy, lithotripsy, stenting or basket extraction.” Or do I use code 50561? I can’t seem to understand the difference between these codes.

Minnesota Subscriber

Answer: The two codes you mention are 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50561 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus).

According to John Piaskowski, CPC-I, CPMA, CUC, CRC, CGSC, CGIC, CCC, CIRCC, CCVTC, COSC, specialty medicine auditor at Capital Health in Trenton, New Jersey, and AAPC consultant and committee chair, “Since your urologist did not perform the stone fragmentation, you should report code 50561 on your claim. The radiology department took efforts to create the access tract [nephrostomy], so your provider technically used an established tract. The acuity of the creation of nephrostomy is irrelevant. As the code description for CPT^® 50561 states ‘exclusive of radiologic service’ the radiology department will report a separate code they for the service they performed.”

Code 50080: When your urologist performs a nephrostolithotomy or pyelostolithotomy to fragment and remove a stone via a percutaneous nephrolithotomy (PCNL) procedure, you should report 50080 or 50081 (… complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)), depending on the stone’s size.

Code 50561: The 50561 service refers to a procedure where your urologist uses an endoscope to access and examine the kidney, renal pelvis, and ureter through an already existing opening. This could be an opening between the kidney’s collecting system and the body’s exterior, or between the renal pelvis and the body’s exterior. During this procedure, the urologist also removes any foreign body or stone.