Urology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: My urologist documents performing a renal endoscopy with tumor resection. There was no established nephrostomy at the onset of the procedure, so should I append modifier -22 to CPT 50562 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor) to indicate that more work was done than is represented in the code? Hawaii Subscriber

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).