Urology Coding Alert

Question: My urologist worked on a patient that showed urethrocutaneous fistula with a tract. He made an incision in the perineum from the base of the scrotum and down to the level of the urethra. The tract was then identified and was freed off the skin and dissected. The tract was divided. Filiform was placed into the bladder, at which time, a ureteroscope was also plac ed through this tract and appeared to be visualized in the bladder. Then the tract was taken down and it seemed to be going down toward the membranous urethra or even prostatic urethra. This was also based on feel and visualization using ureteroscope. At that time, it was decided to open the bladder and try to do a suprapubic cystoscopy to see if the urologist could get a wire in the antegrade fashion. A midline incision was made, taken down the rectus muscle, retracted laterally. This allowed the exposure to the distended bladder. Stay sutures were placed in the bladder. A cystostomy was then made using the cautery.

I don’t see a code for the urethral fistula tract excision. All I can find is 53400 (urethroplasty, first stage, for fistula, diverticulum, or stricture). In coding guideline, it states that this code assumes the urologist will eventually do the second stage (53405) but my urologist is not. He also did urethral dilation filiform and cystostomy. What codes should I report?

Wisconsin Subscriber

Answer: To bill for the closure of the urethrocutaneous fistula, use code 53520 (Closure of urethrostomy or urethrocutaneous fistula). You should also bill for the suprapubic cystotomy using 51040 (Cystotomy, cystotomy with drainage).

Since visualization of the fistula was attempted through the cystotomy and by a ureteroscope via the fistula, also code for this examination with 52000 (Cystourethroscopy [separate procedure]). This latter code is often bundled with the cystotomy code 51040, and not often paid in this clinical scenario, so while you should code the service, you may not be paid for this portion of the procedure.

Append diagnosis code 599.1 (Urethroperineal fistula).