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Question: My urologist removed a kidney stone through a percutaneous approach, but the radiology department obtained the access, and no lithotripsy was performed. Should I still report CPT^® code 50080 even though no lithotripsy was performed, since the code descriptor includes “with or without” lithotripsy, or would code 50561 be more appropriate in this situation? Also, what is the key difference between these two codes?

AAPC Forum Participant

Answer: Let’s start by discussing the differences between the two codes you mention: 50080 (Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)) and 50561 (Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus).

Code 50080: You’ll look to this code when your urologist performs a nephrostolithotomy or pyelostolithotomy to fragment and remove a stone via a percutaneous nephrolithotomy (PCNL) procedure. Depending on the stone’s size, you should report 50080 or 50081 (… complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)).

Code 50561: When this procedure is performed, the urologist advances an endoscope through an existing tract to evaluate the kidney, renal pelvis, and ureter. The tract may connect the kidney’s collecting system or renal pelvis with the body’s exterior. At the same time, the physician may extract any stones they find, or other foreign material.

Since your urologist did not perform lithotripsy or stone fragmentation, you should only report 50561. In this case, because the radiology department established the nephrostomy tract and your physician performed the procedure through that existing access, it does not matter whether the tract was created during the same encounter or beforehand. Because 50561 is reported without any radiologic services, the radiology department may separately bill for creating the access tract.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC