Urology Coding Alert

The Correct Coding Initiative (CCI) Version 7.0 has removed some bundled component codes from CPT 50080 (percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) and 50081 (... over 2 cm). Through its lobbying efforts, the American Urological Association was able to eliminate most of the bundled component codes. Whenever performing a percutaneous nephrostolithotomy, urologists can now bill all of the following codes, if applicable:

50392 (introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous)

50395 (introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous)

52005 (cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service)

52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type])

74420-26 (urography, retrograde, with or without KUB, -professional component)

74475-26 (introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation).

However, it should be noted that 50080 and 50081 are still mutually exclusive for CCI. This means that under no circumstances, even with modifier -59 (distinct procedural service), will Medicare pay for 50080 and 50081 together. If you remove a big stone and a little stone that is smaller than 2 centimeters, use 50080. Code 50081 includes multiple stones that are over 2 centimeters in stone burden.