Urology Coding Alert

Question: We have a patient with an ileal conduit urinary diversion who has renal stones. The doctor performed a looposcopy, loopogram, flexible ureteroscopy, and holmium laser lithotripsy and stone extraction. So far I have CPT 50690 for the loopogram, and 74425-26 for the supervision and interpretation of the x-rays. Should I report 52353 for the lithotripsy and add modifier 52 since the urologist didn't perform a cystourethroscopy?


Illinois Subscriber


Answer: You're on the right track. You should first report 52353 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) for the ureteroscopy and fragmentation of the renal stones. Append modifier 52 (Reduced services) to indicate a reduced service because the urologist didn't perform the cystourethroscopy.

Next, report 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the looposcopy. You'll need to attach modifier 51 (Multiple procedures) to this code because the urologist performed multiple procedures in one operative session.

In addition: For the loopogram, you should report 50690 (Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service). Append modifier 51 to this code as well.

Last: You should report 74425 (Urography, antegrade [pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation) with modifier 26 (Professional component) appended for the interpretation of the x-rays.