Urology Coding Alert

Question: How should I code laser dilation of a ureter- oileal stricture by cystoscopy through the ileal conduit?Pennsylvania SubscriberAnswer: The coding for this procedure depends on the clinical scenario. If your urologist ureteroscopically performed a laser incision of an ileal-ureteral stricture via the ileal conduit, first report 50957 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy).Next, report 44380 (Ileoscopy, through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing...) for the endoscopy of the ileal loop. Attach modifier 51 (Multiple procedures) to 44380 to show the payer that your urologist performed separate procedures on the same patient in the same session.Next choice: If your physician instead performed an incision of a stricture at the ilealureteral anastomosis within the ileal conduit, your coding will change. First report 52290 (Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral) for the cystoscopic incision. Because the conduit represents a substitute bladder, you should use the cystoscopic code but attach modifier 52 (Reduced services) to indicate that the urologist did not perform a cystoscopy.Report 44380 with modifier 51 appended for the looposcopy/endoscopy of the ileal conduit in place of the cystoscopy.