Urology Coding Alert

Question: My physician did a percutaneous nephrostolithotomy but was unable to insert a side-firing Holmium laser fiber through the ureteropelvic junction, and couldn't perform a visual endopyelotomy. So he performed an antegrade Acucise endopyelotomy instead. He performed this procedure through the same incision as the percutaneous nephrostolithotomy. Any coding suggestions?

Florida Subscriber Answer: First, report 50080 (Percutaneous nephrostolithotomy or pyelo-stolithotomy, with or without dilation, endoscopy, lithotripsy, stenting or basket extraction; up to 2cm) or 50081 (... over 2 cm) for the nephrostolithotomy, depending on the size of the stone. Then, report 50575 (Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with endopyelotomy [includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent]) for the endopyelotomy.

The description of 50575 indicates a renal endoscopy plus the endopyelotomy but does not specify a particular method of doing the endopyelotomy. Since the description does not limit you in which endopyelotomy methods it includes, you are free to use it to report the Acucise incision. - Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 21-urologist practice in Indianapolis.