Urology Coding Alert

Question: Is there a code for renal cryosurgery? The urologist made an incision and placed needles in the center of the tumor. He then started a freeze/thaw cycle, similar to prostate cryosurgery. I am familiar with cryosurgery for prostate, but not renal cryosurgery.

Wisconsin Subscriber Answer: You'll need to use 53899 (Unlisted procedure, urinary system) for the cryosurgery. There are no CPT codes for renal cryosurgery outside of a laparoscopic approach (50542, Laparoscopy, surgical; ablation of renal mass lesion[s]). However, check with the carrier involved -- if the patient's insurer accepts HCPCS Level II codes (as some Blue Shield carriers do), consider reporting S2090 (Ablation, open, one or more renal tumor[s]; cryosurgical) for the procedure.

If the urologist also performed an open renal biopsy before the cryosurgery, you could use 50205 (Renal biopsy; by surgical exposure of kidney). If he used an intraoperative sonogram to localize or observe the freezing effects, report 76986-26 (Ultrasonic guidance, intraoperative; Professional component). Append modifier  -26 to show that the urologist did not perform the technical component of the sonogram, only the interpretation. In the latter case, the proper coding would be:

 50205 for the open renal biopsy
 53899 (the unlisted-procedure code) for the cryosurgery
 76986-26 for the intraoperative ultrasonic guidance.