Urology Coding Alert

Question: I have read in the past that it is appropriate to use 52332 when stenting via an ileal conduit, since the conduit is functioning as a "bladder." However, I discovered code 44383, which sounds much more accurate in describing the placement of a ureteral double-J stent when scoping an ileal conduit. Is using 44383 justifiable for the urologist?

Hawaii Subscriber

Answer: No. You should not use 44383 (Ileoscopy, through stoma; with transendoscopic stent placement [includes predilation]) when your urologist places a stent in the ileal conduit. The stents you're describing are external urinary stents, not stents that bypass an intraluminal ileal stricture. Therefore, 44383 would never be the appropriate code for this procedure.
 
Old way: In the past, prior to 2006, you would have used 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) with modifier 52 (Reduced services) appended to report this procedure. This modifier indicated that the urologist exchanged the stent passing through the ileal conduit without performing a cystoscopy.
 
New way: As of Jan. 1, 2006, you should be using 50688 (Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit) when your urologist exchanges a stent in an ileal conduit.
 
A CPT 2006 edit solved the dilemma you're facing when your urologist changes a ureteral stent in an ileal conduit. Code 50688 changed from "Change of ureterostomy tube" to "Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit," making it appropriate to use in the situation you describe.
 
Bottom line: You should use 50688 when your urologist exchanges an externally accessible stent via the ileal conduit. Use this code for unilateral or bilateral stent exchanges.