Urology Coding Alert

Question: The urologist performed several procedures during an operative session:

• Cystourethroscopy and retrograde pyelogram
• Introduction of guide into renal pelvis percutaneously with dilation to establish a nephrostomy tract
• Percutaneous nephrolithotomy with endoscopy and litrotripsy of a 1.5 cm stone
• Retrograde and antegrade pyelogram to delineate percutaneous access and nephrostomy tube placement.

I think that 50080 covers most of these procedures (dilation, endoscopy, lithotripsy, and stenting). Does that mean that I only report 50080 and 74420 for the retrograde? What about the nephrostomy tube placement?

California Subscriber

Answer: We’ll answer each of your questions/issues separately.

• Code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) is correct for a percutaneous nephrostolithotomy, PCNL.
• If the urologist performed the renal access, you can bill 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous). If it was completed prior to the operative procedure in interventional radiology by an interventional radiologist, you cannot bill for it.
• Stent placement, fragmentation, dilation, and basket stone extraction are included in 50080 and accompanying code 50081 (… over 2 cm).
• Submit 50432 (Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation) for the nephrostomy tube placement.
• You should report 74420 (Urography, retrograde, with or without KUB) in addition to 50080. Append modifier 26 (Professional component) to 74420. Remember that KUB is a diagnostic imaging technique of the abdomen; the acronym KUB stands forkidney, ureter, andbladder
• Report 50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access) for the performance and reading of the nephrostogram.

The American Urological Association (AUA) addressed this in its AUA Policy and Advocacy Brief of June 5, 2018. In Coding for Catheters and Stents, the AUA reported that the placement of a nephrostomy tube (50432) at the conclusion of a PCNL is now included in 50080 or 50081 and should not be billed separately. Therefore, your coding will depend on which guidelines you choose to follow. Those options include: