Urology Coding Alert

Question: A few days following a right percutaneous nephrolithiotomy, a patient returned to the operating room (OR) for a procedure to remove remaining kidney stones. The surgeon documented a right percutaneous nephrolithiotomy via the same access tract, the performance of a right antegrade nephostrogram with subsequent interpretation, and a right nephrostomy tube removal. What’s the CPT^® coding?

Idaho Subscriber

Answer: You should take numerous variables into account to reach the correct set of CPT^® codes and respective modifiers. Since this patient is returning to the OR and the surgeon uses the same access tract to perform the percutaneous nephrolithiotomy, reporting code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) a second time would be inappropriate.

Instead, you will find a renal endoscopy code for calculus removal that the physician performs via an existing access tract. In this case, code 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) fits the bill. However, you will notice that the code for the original service performed, 50080, has a global period of 90 days. That means you need to append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 50561 to indicate to the payer that this service was related to the prior surgery.

For the anterograde nephrostogram, report code 74425 (Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation) with modifier 26 (Professional component) appended to indicate that the provider interpreted the scan, but did not own the equipment. You do not need to append modifier 58 to 74425 since this is not a surgical code.

Caution: You should not report code 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access) as this code is bundled into 50561. Furthermore, code 74425 accurately encompasses the imaging services included with the surgery.