GENERAL CODING GUIDELINES - URINARY SYSTEM (50100 - 53899)
1.
In general both
Male and female urinary system related surgical procedures includes the
placement of urinary catheter. Catheterization codes 51701, 51702, and 51703
are not separately reported when done at the time or before other surgical
procedures which require this as part of the procedure.
2.
Renal
allo-transplantation involves three distinct components of physician work, A.
Cadaver donor / Living donor nephrectomy,
- Harvesting the graft and cold
preservation of the graft.
B. Backbench work
and
- Standard preparation of the renal
allograft prior to transplantation.
C. Recipient renal
allo-transplantation.
- Transplantation of the allograft and
care of the recipient
3.
CPT 52204
(Cystourethroscopy with biopsy(s)) this service cannot be billed with units if
multiple biopsies are performed. Only one unit is allowed.
4.
When a biopsy
procedure is followed by destruction or excision of that particular lesion during
the same session then biopsy is included in the major procedure should not be
billed separately. Modifier 59 is allowed if the procedures are performed at
different sessions or different lesions. Multiple biopsies of same type of
lesions can be billed with single unit.
5.
Regarding Endoscopy
procedure:
-
Open procedure
always includes endoscopy procedure if it is performed as part of the open
procedure.
-
Scout endoscopy
should not be reported separately along with diagnostic or therapeutic
endoscopy procedures.
-
Diagnostic
endoscopy is always included in the therapeutic endoscopy.
-
When multiple
endoscopy procedures are performed select the most appropriate CPT code which
describes all the service rendered, or bill the services with modifier 51.
Eg: Renal endoscopy through established
nephrostomy, biopsy of lesion with fulguration is done along with removal of
calculus is performed.
Ans: 50557 & 50561 – 51 (Biopsy is
included)
-
When multiple
endoscopy approaches are necessary to perform at a same session due to
different medical necessity should be coded separately with modifier 51.
Eg: Renal endoscopy with Cystourethroscopy
Note: If multiple endoscopy approaches are
necessary to perform the same procedure at the same session due to complexity
of the condition then code only the successful endoscopic approach.
6.
CPT 51701, 51702
(Insertion of bladder catheter) & 51700 (Bladder irrigation) are reported
only when performed independently.
7.
Don’t report CPT
51784 (EMG) and CPT 51785 (Needle EMG) when EMG is performed as part of
biofeedback.
8. CPT Codes range
from 50740 – 50810 (Ureteral Anastomosis) append modifier 50 or RT/LT if the
procedures are performed in bilateral ureters.
9.
Urethrorrhaphy (CPT
53502 - 53515) is included in urethroplasty procedures, Shouldn’t bill
separately.
10. The insertion and removal of a temporary Ureteral
catheter (CPT 52005) during diagnostic or therapeutic Cystourethroscopy /
pyeloscopy is included in CPT 52320 – 52356 and shouldn’t be coded
separately. To report insertion of a
self retaining, indwelling stent during diagnostic or therapeutic
Cystourethroscopy / pyeloscopy report CPT 52332 in addition to primary
procedure like CPT (52320 – 52330, 52334 – 53252, 52354, 52355) and append
modifier 51.
11. CPT 52332 is unilateral procedure code, for B/L
procedures use modifier 50.
12. CPT 52700 (Transurethral drainage of prostatic abscess)
is included in other transurethral prostatic procedures.
13. CPT 55000 (Puncture aspiration of hydrocele) is
included in services including the tunica vaginalis (Serous membrane that
covers the testes), scrotum, vas deferens and inguinal hernia repairs.
14. Female pelvis examination is included in gynecology
procedures. Shouldn’t be coded separately. Similarly CPT 57410 (pelvic exam
under anesthesia) is included in gynecology procedures.
15. CPT 58660 (Lysis of adhesions) is included in other
major surgical laparoscopic procedures.
16. CPT 57400 (Dilation of vagina) or 57800 (Dilation of
cervical canal) is included in vaginal approach procedures. Unless the CPT
description states “without cervical dilation”.
17. Colposcopy (CPT 56820, 57420, 57452) is included in
surgical procedures.
The above procedures includes the S&I and for bilateral procedure append modifier 50.
PERCUTANEOUS PROCEDURES
NEPHROSTOMY CATHETER:
Placement of Nephrostomy catheter – CPT 50432
- Includes the diagnostic nephrostogram, imaging guidance and S&I
Exchange of Nephrostomy catheter – CPT 50435
- Includes the diagnostic nephrostogram, imaging guidance and S&I
Conversion of Nephrostomy catheter into Nephroureteral catheter – CPT 50434
- Includes the diagnostic nephrostogram and/or ureterogram, imaging guidance and S&I
Removal of nephrostomy catheter requiring fluoroscopy guidance – CPT 50389
Note: For removal without any guidance, then we can bill appropriate E&M service.
NEPHROURETERAL CATHETER:
Placement of nephroureteral catheter – CPT 50433
- Includes the diagnostic nephrostogram and/or ureterogram, imaging guidance and S&I
Removal and Replacement of nephroureteral catheter – CPT 50387
- Required fluoroscopy guidance and Includes the S&I.
Note: For removal alone without any guidance, then we can bill appropriate E&M service.
The above set of codes is for unilateral procedures, for bilateral procedures append appropriate modifier.
Ureteral Stent Procedures
Percutaneous placement of Ureteral stent
1. Via pre-existing nephrostomy tract – CPT 50693
2. Via new access without separate nephrostomy catheter – CPT 50694
3. Via new access with separate nephrostomy catheter – CPT 50695
- Includes diagnostic nephrostogram / ureterogram, imaging guidance and all S&I
Removal and replacement of Ureteral stent via percutaneous approach – CPT 50382
Removal of Ureteral stent via percutaneous approach – CPT 50384
Removal and replacement of Ureteral stent via transurethral approach – CPT 50385
Removal of Ureteral stent via transurethral approach – CPT 50386
The above procedures includes the S&I and for bilateral procedure append modifier 50.