Urology Coding Alert

Question: My urologist indicated that he did a PCNL with antegrade nephrostogram and a Holmium laser fragmentation and nitinol basket extraction of a renal stone which he performed through an existing nephrostomy. Also through the existing nephrostomy he performed ureteroscopy with nitinol basket extraction of stone fragments from the ureter. At the conclusion of the procedure the urologist replaced the nephrostomy tube. How should I code this procedure?

Codify Member

Answer: Unfortunately, there really is no "perfect" code for the second part of the procedure. The best option for reporting this procedure is as follows:

• 50080 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm).
• 50961 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus). Append modifier 51 (Multiple procedures) if you are billing to a non-Medicare payer requiring that modifier. Otherwise, do not append the 51 modifier.
• 50394 (Injection procedure for pyelography [as nephrostogram, pyelostogram, antegrade pyeloureterograms] through nephrostomy or pyelostomy tube, or indwelling ureteral catheter). Add modifier 51 if necessary.
• 50398 (Change of nephrostomy tube or pyelostomy tube). Add modifier 51 if necessary.

The fact that your urologist performed the procedure through the patient's existing nephrostomy opening does not change the way you code the procedure.