Answer: Your keen observation skills have done you a great service by recognizing that code 50562 indicates that a nephrostomy or pyelostomy has already been established through which the renal endoscopy can be performed. But modifier -22 (Unusual procedural services) isn't the way to go about receiving the additional reimbursement your urologist deserves for having to establish the nephrostomy at the time of the procedure. Choose codes to represent the establishment of the nephrostomy and the subsequent percutaneous resection.
You should report the codes that represent the individual components of establishing a nephrostomy. Code one or any of the following depending on his documentation:
Renal access code CPT 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous)
Nephrostomy tube placement code Cpt 50392 (Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous)
Nephrostogram code 50394 (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter)
Nephrostogram reading and interpretation code 74425-26 (Urography, antegrade, [pyelostogram, nephrostogram, loopogram], radiological supervision and interpretation; Professional component).
Remember to sequence code 50562 first because it has the highest relative value units. You should also append modifier -51 (Multiple procedures) to codes other than the primary procedure (50562).
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