Urology Coding Alert

Question: Our doctor attempted to exchange an externally accessible ureteral stent exiting from the stoma of an ileal conduit but was unsuccessful. After approximately an hour and a half of those efforts he elected to perform a cystoscopy of the patient's loop to see if a guidewire could be passed alongside the ureteral stent. This also was unsuccessful. The patient has Medicare insurance. Can I bill 50688 and 52000 with modifier 52?

Texas Subscriber

Answer: First, report 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) for the procedure. Append modifier 52 (Reduced services) since your urologist did not complete the full procedure even though he spent an extended amount of time.

Then report 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the ileoscopy -- an endoscopic examination of the loop.

Caution: There is no indication in the information you provided that your urologist performed a cystoscopic examination of the bladder. Therefore, 52000 is not an appropriate code to report.