Urology Coding Alert

Question: My physician removed a stone percutaneously via access performed by radiology. My physician did not perform a lithotripsy. Does code 50080 require lithotripsy? The definition in CPT^® says “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.

AAPC Forum 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).

Since your urologist did not perform stone fragmentation, you should report code 50561 on your claim.

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 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm), depending on the stone size.

Code 50561: With a 50561 service, your urologist inserts an endoscope through a previously established opening between the collecting system of the kidney and the exterior of the body or a previously established opening between the renal pelvis and the exterior of the body. Your urologist then examines the kidney, renal pelvis, and ureter, and removes a foreign body or ston