Wiki laparoscopic pyeloplasty with stent placement - CPT help for the stent placement

[Miko24]

My provider did a pyeloplasty and also placed a stent by inserting a 6x28 stent through the anastomosis and down into the bladder. The proximal curl is then placed within the renal pelvis.

I do not believe that the stent placement is included in the procedure. I am looking for a cpt code for that stent placement...

52332 or 50605????

 

[liqgold2@aol.com]

Neither one is correct on its own. There is no specific laparoscopy code for stent insertion after laparoscopic pyeloplasty, 50544. Therefore. use the unlisted laparoscopy code, ureter, 50949 and bench mark to the open code 50605.

 

[m.edwards]

Per the NCCI manual, Chapter 7 "A ureteral stent is commonly inserted at the site of an anastomosis of a ureter and another structure to maintain patency of the ureter. A ureteral stent is also often inserted into a ureter if the ureter is incised during a procedure (e.g., nephrectomy, cystectomy, ureteral anastomosis). With these procedures, insertion of the ureteral stent is integral to the procedure and is not separately reportable. For example, CPT code 50605 (Ureterotomy for insertion of indwelling stent, all types) shall not be reported with CPT codes describing cystectomy, urinary diversion, or ureteral anastomosis for insertion of a ureteral stent to maintain patency at the site of a ureteral anastomosis." Therefore, it would be considered included/integral to the 50544.

 

[kkaras]

Codify states to use CPT 52332 with 50544 for the stent placement.... do we think things have now changed or have been clarified elsewhere? I can't seem to find anything to back this up. There are no NCCI edits between the CPTs, but I am seeing Medicare Advantage Plans denying as incidental/bundled. As well I would inherently think you SHOULDNT use the 52332 as the stent is not being placed via cystoscopy and instead being done with the laparoscope instrumentation.

 

[daniel]

If not being placed via cystoscopy, then follow the logic of not using 50605 with 50400 with Laparoscopic. This is supported by m.edwards posted above, the rule doesn't change because it's laparoscopic. Only context we can code at stent, is for a cysto stent placement 52332.

Hope that helps.