Radiology Coding Alert

Question: My radiologist did a CT-guided drainage of a renal cyst with contrast injection via an existing drainage catheter and alcohol sclerotherapy of the cyst cavity. How should I code this? I found a code for drainage of a hepatic cyst but can't find one for renal.

Michigan Subscriber

Answer: For renal cyst drainage done under CT guidance, you should report CPT 50390 (Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous) and 76360 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation).

Because you also indicated sclerotherapy of the cyst cavity, use 53899 (Unlisted procedure, urinary system). As always with an unlisted-procedure code, provide adequate documentation to tell the insurer what the doctor did, why you should get paid, and what fair reimbursement would be. Most sclerotherapy is provided under fluoroscopic guidance, so be sure you code for that. You may need to over-ride an NCCI Edits in doing so, but this is one separate and distinct procedure that justifies doing just that.

The contrast injection of the existing drainage catheter is often included in the primary procedure, unless a separately identifiable diagnostic imaging service is performed. In the case of cyst sclerotherapy, such an injection is performed to learn prior to the treatment whether the cyst is in communication with the renal collecting system. If it is, you can't inject the sclerosing solution, so this type of cyst study should be coded separately.