Urology Coding Alert

Question: One of our urologists was called into the OR to do a bladder and ureteral repair after another surgeon injured both structures during surgery. Our urologist repaired the bladder wound via a robotic approach (other surgery was already setup robotically). After the robotic bladder repair, our urologist discovered via ureteroscopy that the ureter was also damaged, and opened up the patient’s abdomen to re-implant the ureter into the bladder. The urologist also placed a ureteral stent. I have chosen 50780 for the open repair, but I am not sure of what to code, or if the robotic bladder repair should be coded. Also, can I report the stent?

Oregon Subscriber

Answer: First, report 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) for the open reimplantation of the injured ureter. Attach modifier 52 (Reduced services) because the field had already been set up by another physician for the robot. You’ll use diagnosis codes 867.2 (Injury to ureter without open wound into cavity) and 998.2 (Accidental puncture or laceration during a procedure…) for this part of the procedure. 

Next, report 52351 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic) for the ureteroscopy, again with diagnoses 867.2 and 998.2.

Since there is no code that describes the robotic/laparoscopic repair of the bladder injury, you will need to use the unlisted code: 51999 (Unlisted laparoscopy procedure, bladder). Attach diagnosis code 867.0 (Injury to bladder and urethra without open wound into cavity) for this part of the procedure.

Watch out: Placement of a ureteral stent at the time of ureteral reimplantation is included in code 50780 and you cannot bill separately for it.