Urology Coding Alert

Question: I need to code the following: hand assisted laproscopic cryosurgery converted to open cryoablation of 2 renal masses with intraoperative renal ultrasound of both masses. What codes do you suggest?

South Carolina Subscriber Answer: Because your urologist performed an open procedure to accomplish the cryosurgery, you must then use an open code instead of a laparoscopic CPT code. Unfortunately, however, no CPT code describes an open cryosurgical treatment of renal masses. Therefore, for Medicare patients, you must use an unlisted procedure code (53899, Unlisted procedure, urinary system) for the open cryosurgery of the two renal masses. Bill ultrasonic guidance 76940-26 (Ultrasound guidance for, and monitoring of, visceral tissue ablation; professional component) in addition to the cryosurgical procedure code. Append modifier -26 to show that the urologist in the hospital interpreted the sonogram but does not own the equipment and did not perform 76940's technical component.

For private carriers, especially Blue Cross Blue Shield, consider using HCPCS code S2090 (Ablation, open, one or more renal tumor[s]; cryosurgical). First, however, check with the carrier to determine if they recognize this code. Also report 76940-26 for the ultrasonic guidance.