Urology Coding Alert

Question: One of my doctors performed a robotic assisted laparoscopic pyeloplasty for severe hydronephrosis secondary to ureteropelvic junction obstruction. He also indicates that he did a placement of a double J stent. The patient has a previously placed nephrostomy tube. Documentation states, “The stent was then passed via the open renal pelvis into the bladder, and the proximal end was then placed into the renal pelvis.” My question is can I bill for the placement of the stent? I was looking at 50605, but the CPT^® manual indicates this placement of the stent is performed through a ureteral incision. Our coders think it is included in the procedure and not billable, but we want to make sure.

Connecticut Subscriber

Answer: The placement of a stent at the time of a UPJ repair is included in the operative code 50544 (Laparoscopy, surgical; pyeloplasty).

CPT^® rules have stated that the open placement of stents or catheters passed during open ureteral or uretero-pelvic junction repairs are included in the procedure itself. Although not clearly stated for similar laparoscopic repairs, the thinking also should hold true for laparoscopic procedures.

The code you mentioned, 50605 (Ureterotomy for insertion of indwelling stent, all types), is an open procedure and is only for a ureterostomy and placement of a stent in an intact ureter, not to be billed or included for repairs of transected ureters or for ureteral reimplantations. It would not be appropriate for the procedure you describe.