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Coding for Kidney, Ureter and Bladder Procedures

Coding for Kidney, Ureter and Bladder Procedures. Jack S. Elder, M.D., FAAP. Case 1: Infant with UPJ obstruction. Open dismembered pyeloplasty Insertion of double J stent (through open ureter) Intercostal nerve block . Pyeloplasty Codes.

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Coding for Kidney, Ureter and Bladder Procedures

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  1. Coding for Kidney, Ureter and Bladder Procedures Jack S. Elder, M.D., FAAP

  2. Case 1: Infant with UPJ obstruction • Open dismembered pyeloplasty • Insertion of double J stent (through open ureter) • Intercostal nerve block

  3. Pyeloplasty Codes • 50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting, simple 19.47 • 50405 Pyeloplasty complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty) 23.89

  4. Pyeloplasty Codes • 50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting, simple 19.47 • 50405 Pyeloplasty complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty) 23.89

  5. Ureteral Stenting Codes • 50605 Ureterotomy for insertion of indwelling stent, all types 15.44 • 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous4.15

  6. Nerve Blocks • 64420 Intercostal nerve, single 1 level 1.18 • 64421 Intercostal nerve, multiple, regional block 1.68 • 0.125% bupivacaine with 1:200,000 epinephrine • 64425 Ilioinguinal, iliohypogastric nerves 1.75

  7. Consensus • Pyeloplasty 50405 23.89 • Intercostal nerve block 64421 1.68 • ?? Open insertion of ureteral stent 50605 15.44

  8. Case 2: 10 yo child with UPJ obstruction • Cystoscopy, insertion of ureteral catheter • Laparoscopic dismembered pyeloplasty • Antegrade insertion of double J stent

  9. Laparoscopic Pyeloplasty • 50544 Laparoscopy, pyeloplasty 22.37 • 52005 Cystourethroscopy, with ureteral catheterization 2.37

  10. Ureteral Stenting Codes • 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous4.15 • 50572 Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, with ureteral catheterization, with or without dilation of ureter 10.33 • 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

  11. Ureteral Stenting Codes • 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15 • 50572 Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, with ureteral catheterization, with or without dilation of ureter 10.33 • 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

  12. Consensus • 50544 Laparoscopy, pyeloplasty 22.37 • 52005 Cystourethroscopy, with ureteral catheterization 2.37 • 50393Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15 OR • ?? Renal endoscopy through nephrotomy or pyelotomy, with ureteral catheterization, with or without dilation of ureter 10.33

  13. Case 3: 4-year-old boy with refluxing megaureter • Ureteral tapering • Ureteral reimplantation with psoas hitch • Insertion of double-J catheter

  14. Pertinent Ureteral Tailoring Codes • 50700 Ureteroplasty, plastic operation on ureter (e.g., stricture) 15.19 • 50783 Ureteroneocystostomy, anastomosis of single ureter to bladder with extensive ureteral tailoring 20.52 • 50785 Ureteroneocystostomy, anastomosis of single ureter to bladder with vesico-psoas hitch or bladder flap 20.49 • ??50785-22

  15. Consensus • 50785 Ureteroneocystostomy, anastomosis of single ureter to bladder with vesico-psoas hitch or bladder flap 20.49 • 50700 Ureteroplasty, plastic operation on ureter (e.g., stricture) 15.19 • 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

  16. Case 4: 3 yo girl S/P TUI ureterocele as infant; has functioning RUP and reflux into upper and lower poles • Cystoscopy • Open excision of ureterocele • Upper-to-lower ureteroureterostomy • Ureteral reimplantation, lower pole ureter

  17. Consensus • 52000 Cystoscopy 2.01 • 51535 Cystotomy for excision, incision, or repair of ureterocele 12.55 • 50760 Ureteroureterostomy 18.39 • 50780 Ureteroneocystostomy, anastomosis of single ureter to bladder 18.33

  18. Case 5: 3 yo girl S/P TUI ureterocele as infant; has functioning RUP and reflux into upper and lower poles • Cystoscopy • Open excision of ureterocele • Tapering of upper pole ureter • Common sheath ureteral reimplantation • Insertion of double-J stent

  19. Consensus • 52000 Cystoscopy 2.01 • 51535 Cystotomy for excision, incision, or repair of ureterocele 12.55 • 50783 Ureteroneocystostomy, anastomosis of single ureter to bladder with extensive ureteral tailoring 20.52 (alt. 50700 + 50782) • 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

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