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
50400 Pyeloplasty (Foley Ypyeloplasty), 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
Pyeloplasty Codes
50400 Pyeloplasty (Foley Ypyeloplasty), 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
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, percutaneous 4.15
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
Consensus
Pyeloplasty 50405 23.89 Intercostal nerve block 64421 1.68 ?? Open insertion of ureteral stent 50605 15.44
Case 2: 10 yo child with UPJ obstruction
Cystoscopy, insertion of ureteral catheter Laparoscopic dismembered pyeloplasty Antegrade insertion of double J stent
Laparoscopic Pyeloplasty
50544 Laparoscopy, pyeloplasty 22.37 52005 Cystourethroscopy, with ureteral catheterization 2.37
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
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
Consensus
50544 Laparoscopy, pyeloplasty 22.37 52005 Cystourethroscopy, with ureteral catheterization 2.37 50393 Introduction 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
Case 3: 4-year-old boy with refluxing megaureter
Ureteral tapering Ureteral reimplantation with psoas hitch Insertion of double-J catheter
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
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
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
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
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
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