Reader Question: Submit Multiple Codes for Complicated PCNL- Published on Tue, Jun 14, 2016
Question: The surgeon did a cystoscopy and retrograde pyelogram to aid in renal access, a percutaneous renal access and dilation, a percutaneous lithotripsy, PCNL, of a renal pelvic stone >2cm, and an antegrade ureteroscopy and removal of a distal ureteral stone. He then placed a nephrostomy tube and did an antegrade nephrostogram. How should I code this scenario?
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Answer: Apply the following codes to your clinical scenario:
50081 (Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm) for the PCNL with diagnosis N20.0 (Calculus of kidney); this includes the nephrostomy drainage at the end of the case
50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous) for the renal access
52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) for the cystoscopy and retrograde pyelogram
50961 (Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) with modifier XS (Separate structure) for the ureteroscopic ureteral stone removal with associated diagnosis N20.1 (Calculus of ureter)
50431 (Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance [e.g., ultrasound and fluoroscopy] and all associated radiological supervision and interpretation; existing access) for the performance of the nephrostogram, including interpretation, via an existing access.