Urology Coding Alert

4 new renal pelvis catheter codes reflect emerging technologies

On Jan. 1, you'll have several new codes that you can use for your urology coding, including one for open cryoablation and one for renal ablation. The new codes better reflect the new technology urologists are using, and they will also keep you from having to use unlisted-procedure codes. Avoid Unlisted-Procedure Code With 50250, 50592 CPT Codes 2006 adds two codes for the treatment of renal mass lesions:

• 50250--Ablation, open, one or more renal mass lesions(s), cryosurgical, including intraoperative ultrasound, if performed

• CPT 50592 --Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency. The open cryoablation code, CPT 50250 , is a welcome addition, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis. Before this new code, you had to report an open partial nephrectomy (50240, Nephrectomy, partial), which did not correctly reflect the true technique, or an unlisted-procedure code, CPT 53899 (Unlisted procedure, urinary system).

Tip: 50592's descriptor specifies unilateral, so if your urologist performs the procedure on both sides, you should append modifier 50 (Bilateral procedure) to indicate that the procedure was bilateral.

Also, the descriptor has no intraoperative radiological inclusions, so you can separately report radiological monitoring during the surgery. For example, if your urologist uses a computed tomography (CT) scan for location and monitoring of the tumor's response to the percutaneous radiofrequency, you should report 76362 (Computed tomography guidance for, and monitoring of, visceral tissue ablation).

If your urologist uses magnetic resonance imaging (MRI), report 76394 (Magnetic resonance guidance for, and monitoring of, visceral tissue ablation), and if he uses ultrasound, report 76940 (Ultrasound guidance for, and monitoring of, visceral tissue ablation).

Don't overlook: For percutaneous cryotherapy ablation that you report after Jan.1, you'll use Category III code 0135T (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy). 4 Stent Codes Offer Better Options for New Technology You have four new codes to use for the removal or exchange of ureteral or nephroureteral stents:

• 50382--Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

• 50384--Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

• 50387--Removal and replacement of externally accessible transnephric ureteral stent (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

• 50389--Removal of nephrostomy tube, requiring fluoroscopic guidance (e.g., with concurrent indwelling ureteral stent). The four new codes reflect new technologies, Hause says. Prior to the 2006 CPT changes, you haven't had appropriate codes to report these types of procedures.
 
Bonus: When your urologist percutaneously removes and replaces an indwelling ureteral stent on both sides, you can report 50382 and append modifier 50 (Bilateral procedure).

Note: "Urologists remove [...]