Urology Coding Alert

Question: The urologist performed a right percutaneous nephrostolithotomy for a stone greater than 2 cm, a nephrostomy tube exchange, a nephrostomy tube track dilation for access to renal pelvis, and an antegrade ureteral removal of two encrusted stents, using fluoroscopy. Should I be reporting 50081 and 50398?


Wisconsin Subscriber


Answer: You're partly correct. You should report 50081 (Percutaneous nephrostolithotomy or pyelosto-lithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm) for the percutaneous nephrostolithotomy. You're also right that you should report 50398 (Change of nephrostomy or pyelostomy tube) for the nephrostomy tube exchange. Append modifier 51 (Multiple procedures) to 50398 to indicate that the urologist performed the tube change along with other procedures.

In addition: You also need to report 50561 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, installation or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) for the renal endoscopy and the removal of the foreign bodies, which were the double-J stents. Attach modifier 51 to 50561 as well.

Warning: CPT includes the dilation of the tract in code 50081, and the fluoroscopy is in code 50398. Therefore, you should not separately report either of these services.