Urology Coding Alert

Question: I’m working on an operative report that involves a laser ablation of ureteral calculus. However, I can’t seem to figure out what code to report for this portion of the surgery:

Next, we replaced the previous nephrostomy catheter with an 18-French Councill tip Foley catheter with 5mL acting as a percutaneous nephrostomy tube into the collecting system, which was confirmed by an antegrade pyelogram. The nephrostomy tube was secured via a 2-0 silk stitch to the skin. The nephrostomy tube was capped.

What CPT^® code(s) should I report?

Arizona Subscriber

Answer: Report this portion of the surgery with 50435 (Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation). This part of the service involves the surgeon exchanging an existing nephrostomy catheter with a new one. The exchange of the nephrostomy tube is likely due to the fact that the patient has a long-term urinary condition that typically results in obstruction of the kidneys, ureter, or bladder. The provider will need to exchange nephrostomy tubes every 8-12 weeks in order to prevent tube obstruction from encrustation.

Nephrostomy exchange via 50435 includes all imaging guidance and supervision. Furthermore, it includes the injection portion of the antegrade pyelogram, ruling out reporting of 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access) separately.