Urology Coding Alert

Question: How should we code for a pouchoscopy with holmium laser lithotripsy of Indiana pouch stones?

Missouri Subscriber Answer: You should use CPT 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or 44385 (Endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), depending on the type of intestinal pouch in question, and append modifier -22 (Unusual procedural services) to indicate the extra work in fragmenting or removing the foreign-body stone lodged in the loop or pouch.
 
When precertifying the procedure, give these codes but also indicate the extra work the urologist will do and the reasons you'll be adding modifier -22. 
 
-Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, New York; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.