Urology Coding Alert

Question: A patient presented to our office with a stone in his Kock pouch. The urologist performed an ESWL requiring multiple positioning due to stone movement. The physician wants me to use code 50590. Since the stones were not actually in the kidney, would this be appropriate or just the closest to it? Also, what diagnosis code should I use?

California Subscriber Answer: No, 50590 (Lithotripsy, extracorporeal shock wave) is not the best code for you to use for the shock wave treatment of stones in a Kock pouch. You should instead report 44799 (Unlisted procedure, intestine) for this procedure.
 
Tip: Anytime you use an unlisted-procedure code you should prepare an operative report and a short explanatory note explaining what the surgeon did and why. Benchmark the procedure with a similar CPT code.
 
In this case, you should mark code 50590 as being a similar procedure with comparable equipment, work, and skill required.
 
You should use ICD-9 code 936 (Foreign body in intestine and colon) to represent the stone in the intestinal pouch necessitating the shock-wave treatment.