Urology Coding Alert

Question: The urologist completed cystoscopy with left retrograde pyelogram, left ureteral stent placement, left percutaneous access, left percutaneous nephrostolithotomy, nephrostomy tube placement, and ureteral catheter placement. How dowe code all of these procedures from the same operative session?

Arizona Subscriber

Answer: You will report several codes, based on your description of all the services provided. Before reporting everything, ensure that your provider’s documentation clearly supports each one. The following codes apply:

• Cystoscopy with left retrograde pyelogram: codes 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) and 74420-26 (Urography, retrograde, with or without KUB) (Professional component)
• Left percutaneous access (a recent addition by the AUA for 2019): 50432-52 (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) (Reduced services)
• Left percutaneous nephrostolithotomy: either code 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm) or 50081 (… over 2 cm), depending on the size of the stone fragmented not the stone burden

Nephrostomy tube placement and ureteral catheter placement at the conclusion of the PCNL procedure are now included in CPT^® codes 50080 and 50081 as per the American Urological Association, AUA, white paper on Coding for Ureteral Catheters and Stents as reported in the AUA Policy and Advocacy Brief of June 5, 2018 and are not now separately billed.